retracting DFS complaint number CSB-2020-01351366

As I emailed the New York State Department of Financial Services earlier today:
I have been unable (last night and so far today) to log into the DFS portal where I submitted this complaint yesterday.   I was told to email your agency here.
I withdraw complaint CSB-2020-01351366.  Healthfirst had nothing to do with this termination of my ACA health insurance.   They might have informed me of the impending loss of my insurance, which they knew of for three weeks before it was terminated, although they likely had no legal duty to do so and every business reason not to.   My complaint should not go to Healthfirst.
 
My insurance was terminated by the NYSOH, for my own oversight, which remained uncorrected for lack of effective notice of the mistake by NYSOH.  I have since been able to correct this oversight and my insurance will be restored effective 5/1/20.  
Please terminate this complaint.  

Low-Income Funnies, Pandemic Edition

Because I get my low-cost health insurance through Obamacare, the Patient Protection and Affordable Care Act of 2010 (ACA), I am required to re-enroll every year.  I do this, along with every other low-income New Yorker without employer-based insurance, during the relaxing weeks just before Thanksgiving to just before Christmas.   The ACA is administered in New York State by an overwhelmed agency called the New York State of Health Marketplace.  ACA health coverage is, as we learn, an easy-come easy-go form of health insurance.

The “entitlements” our government generously extends to people of low income are precious, sometimes matters of life or death.   Oddly, such benefits can be instantly clawed back with little or no notice to those who benefit from the programs, if the poor sucker makes a simple but inexcusable mistake.  I used to see this all the time when I represented some of the poorest and most desperate New York City tenants, most of whom I was able to save from homelessness.  

A wheelchair-bound double amputee got a late notice of a “face to face” meeting she was required to attend to keep her housing voucher intact.  She was unable to schedule Access-A-Ride on one day’s notice.  I spent over a year, thirteen times in Brooklyn Housing Court, trying (and in the end succeeding) to restore her housing benefits and prevent her eviction.  The government’s attitude was that this lazy bitch should have found a way to be at that meeting if she wanted continued assistance paying her rent.

So it was for me, years later, that the New York State of Health decided that the fatal December 6 mistake in my 2020 application had gone unaddressed for long enough.  On Good Friday (I’ve had better Fridays) I was informed that my health insurance had been cancelled on March 31, 2020.  I had no notice of the cancellation until I tried to use my insurance again in April.  

From a legal point of view, it is debatable whether I had notice from NYSOH before they terminated my health insurance.   I had the scantest fig leaf of legal notice of my original oversight and what action I needed to take to correct it; two letters in the inbox of New York State of Health’s website, a place otherwise uninsured New Yorkers visit once a year when we are forced to log in to reapply.  

True I had no emails from NYSOH telling me to check the inbox on their website on pain of losing my health insurance during a pandemic (I had several emailed ads for the handy new NYSOH phone app during this time), or any notice by regular mail (as their web-posted letters claimed I’d had) but NYSOH inserted both long, detailed legal warning letters right there in my on-line inbox, on December 7 and March 11, to be used as conclusive proof of notice in the event of a lawsuit by the disgruntled former recipient of government-subsidized health insurance.

I finally learned of my easily fixable mistake, after 74 hours of life-shortening stress and anger, while talking about my legal options with an old friend from law school (an online Article 78 to challenge the arbitrary and capricious cancellation of my insurance without reason given, or notice). Once I discovered it (tip of the hat to you, Jon) it was a matter of about 20 minutes on-line to fix my December 6 omission, re-apply and have my health insurance restored effective May 1, 2020.  [1]

My December 6 omission, by the way, was failing to include proof of income I didn’t receive until several weeks later.  My insurance was, I was informed in the first of these on-line letters I didn’t see, conditional, its continuance beyond March 31 depended on me fixing this mistake before that date, and I simply, willfully, refused to comply with the part of the law I’d forgotten about this time.

If I’d had actual notice of the problem, on the date of their second notice, I could have easily updated my application, fixed the fatal problem in March and avoided any interruption in my health insurance coverage.  

You have to admit, it’s funny as plague-infected shit, in a certain sick and deadly way.  May you and your loved ones never know from such hilarity.   God bless the child that’s got his own and God bless these United Shayyyysssssh.   

 

[1] Fortunately I discovered what I needed to do and re-applied before April 15.  If I’d re-enrolled after the 15th, my insurance would not start until June 1.

Education and Clarity of Language might not help you

Yesterday’s attempt at an Op Ed for the Grey Lady ended with this now deleted paragraph about the seeming impossibility of getting my improperly terminated health insurance back during a raging plague.  Observe the plangent notes of heroic  self-pity:

So I am left to accept my punishment and practice mindfulness.  I sit here lowering my blood pressure, and my heart rate, by thinking of the miracle of communication — how I can sit and convey these deeply fearful things to a stranger, merely by arranging the words properly on a page.  I hope someone will remember I did this when they are lowering my body into a mass grave.   My murdered ancestors would want no less for me.

Admittedly, useless — DELETE! — though I do still greatly appreciate the miracle of written communication, as far as it goes sometimes.  Nothing like writing the situation out clearly when you are in great trouble or danger.

Today I wrote this concise complaint to the NYS Department of Financial Services, the NYS agency that regulates all insurance, financial houses, hedge funds, banks, etc. in New York State,  My latest attempt to take a flying fuck at a rolling donut (though their on-line consumer complaint form immediately fixed a similar insurance termination without notice problem back in January):

I was informed Friday afternoon, when I called my insurer after being told by a doctor that my insurance came up “inactive,” that my Healthfirst health insurance, prepaid through June, had been cancelled, effective March 31 by the New York State of Health Marketplace. According to Healthfirst, no reason for this termination was given by NYSOH.

NYSOH, I was told, had sent Healthfirst notice of their intent to terminate my ACA insurance on March 11.  Neither Healthfirst nor NYSOH provided me any notice of this termination, not prior to the effective date nor since.

I am instructed to call NYSOH, an overwhelmed and unresponsive agency on a good day, where one hears this recording:

New York State of Health is experiencing high call volume.  Because of the public health emergency we are extending the due date for people who are expected to renew before April 15.   You will receive another notice of the new due date before any changes will be made to your coverage.   You do not need to take any action at this time.  

Also, because of a new federal law, no person who currently has Medicaid coverage will lose their coverage during this emergency.  If you are enrolled in Medicaid and get a notice from New York State of Health telling you that your coverage will end after March 18, 2020, you can disregard this notice.  You will have no gap in coverage.  If you have Medicaid you do not need to report any changes to your account except a permanent address change.

I have to assume that termination of prepaid health insurance without notice violates some NYS law, administrative rule or something, in addition to the due process protection of the US Constitution and the PPACA.  One searches for New York’s legal answer to this question in Titles 10 (Health) and 11 (Insurance) of the New York Codes, Rules and Regulations  in vain, there is no chapter on point. 

(I was wisely advised to follow my hunch and delete this line:  I am still waiting (since early February) to hear back from your office for a citation to the text of the controlling law.)

Can you help me get my improperly terminated insurance back during this worldwide plague? I’d be eternally grateful.

Alternatively, can you direct me to the nearest rolling donut?

You Have the Right Not To Be Angry

If you are not wealthy in this country, you have a very limited right to express anger publicly.   Anger, like health care, is a privilege in America, not a right.

A wealthy person who feels aggrieved may hire a team of lawyers to legally bludgeon the person who inflicted the injury.   An angry wealthy person may take out a full-page ad in the newspaper of record, calling for vengeance against someone he hates.   Our current president did this, as a private citizen, when he purchased a full-page of the New York Times to call for the death of five boys locked up for, and eventually exonerated of, a heinous crime.    Anger is all the rage among the rich and powerful.  It is a luxury not permitted to the weak.

I was told in no uncertain terms in January, mistakenly it turns out, that my Affordable Care Act health insurance had been properly terminated without notice, for my failure to do something I had no notice of.   I’d been told by the insurance company that everything I needed to do to have 2020 health coverage had been done.  Then they informed me I had no health insurance because I’d failed to pay a “binder” during a once-a-year ten day grace period that nobody told me about.  The invoice made no mention of a do-or-die grace period.

I had no warning, no chance to fix what they told me was fatally broken in our contract.   This lack of a heads-up struck me as fundamentally unfair, as it probably is, except in a world where superhuman corporate “persons” rule over regular puny earthling persons who proceed at our own peril.

I was angry about this, even after the multiple complaints I submitted resulted in the reversal of this irreversible decision.   Within a very short time I had my insurance restored;  in fact, I had a call from the insurance company apologizing and telling me that my insurance had never actually been terminated.   I rescheduled a canceled cardiologist appointment and had an expensive treatment paid for by the insurance company, at about 30% of the uninsured sticker price, with only my co-pay required from me.

Still, I was irked about the lack of accountability for a health insurance company that had made me suffer agonizing anxiety as I exerted myself mightily to find the hidden legal remedy (hint: NYS Department of Financial Services).  I am pretty sure that the “mistaken” termination had been unlawful, this seems clear by how quickly the final determination against me was changed.  

To my dismay, nobody I spoke to in the city, state or federal bureaucracy could tell me what that violated law was, not its name, its existence, what exact patient protections it contained.  I wanted to see the text of the law, to read the precise patient protections my health insurance provider had ignored, to such unfair and frightening effect.  It is apparently not the right of a powerless citizen to have this kind of information.

I began lashing out in letters and emails, and on the phone.  A Resolution Specialist from Healthfirst called and promised me a written apology and a record of the many calls I’d had with the insurance company, which would allow me to trace exactly what had been done to me and how it had been corrected.   I wanted a roadmap of how the unknowable law had been violated.  I feel a strong need to inform others in my situation of their rights and legal remedies.   None of what I was promised by Healthfirst was delivered.  

I became increasingly unsettled, as my case was repeatedly “escalated” and never resolved.  I included some inflammatory remarks in letters and phone calls and asked pointed questions about some very obvious things.  

For example: due process is guaranteed in our constitution.  It is fundamental to a free society that people have the right to some kind of hearing, some process, before they can be deprived of something they legally own.  In my case, I’d re-enrolled for coverage in time and subsequently paid for my health insurance through June.  How was it legal to void our contract without notice to the consumer?

As if in answer to this question, I was informed on Good Friday, during this pandemic (not a very good Friday for me) that my insurance had been terminated again, without so much as an email to inform me of this sobering fact, and without any reason given, effective March 31, 2020.

I learned this when I had a call from a doctor I was scheduled to see (over the phone) on Wednesday telling me my insurance came back “inactive.”  When I called Healthfirst to snarlingly enquire, the rep confirmed that they had been instructed to terminate my insurance by the New York State of Health Marketplace, the state’s sole purveyor of Patient Protection and Affordable Care Act health insurance policies.

In the absence of law, those with the power to do so can freely oppress those who are powerless.   If you have no power, you must not be angry about this.  Anger is so bad for your health, your immune system, all of your relationships!

I was told the New York State of Health contacted Healthfirst on March 11, instructing the private corporation to terminate its contract with the patient.  No reason was given.   Any day between March 11 and March 25 would have been an ideal time for either or these entities to inform the patient of the jeopardy he was about to face (no health insurance during a worldwide plague) and the need for immediate action on his part to prevent the loss of the insurance he’d already paid for.  

There was no email, phone call or letter — none from Healthfirst, none from the so-called New York State of Health.   Healthfirst sent me a notice that my ongoing cardiac treatment had been approved through July, an invoice showing that my premiums were paid through June, and numerous instant email reminders that I’d not taken the voluntary customer satisfaction survey after each call.   Not a peep about the insurance cancelled ten days before I found out about it when a doctor’s office alerted me to it.

Had the doctor’s office not called, I’d still be blissfully unaware that my health insurance has been quietly null and void for thirteen days and counting.  Seems there should have been some legal process due before a patient is deprived of healthcare during a pandemic, no?

The well-paid CEO of Healthfirst would be perfectly within her rights to be furious at me, after being subjected to provocative lines like these, no matter how otherwise accurate they might be:

A corporate “person” is an appetitive psychopath, without conscience or remorse, driven to devour and only constrained by the rare regulation in place to restrain the gnawing impulse to maximize profits, a corporation’s only legal imperative.

The removal of health insurance during a plague is arguably an excessive punishment for an impolitic expression of something that is well-known: private health insurance corporations have every incentive to cull from their rolls older, low-income patients who cost them far more in medical care than they pay in premiums.   That’s just good business sense, however else one might feel about it.  

Why the New York State of Health intervened a month ago, as I was told by Healthfirst the other day, with no reason given, to terminate the ACA insurance of a customer who had re-enrolled and completed his end of the contract with a private insurance company is a question I will not be able to get an answer to any time soon.   During this terrible plague, everyone is overwhelmed, many mistakes are made, lines for help are very long and it is best to stay calm, even when provoked to great fear and anger.  Particularly if you are powerless in a state ruled by the bottom line.

That said, it would be a wonderful thing for citizens to actually be allowed to know the laws that protect them from arbitrary and capricious decisions with terrifying consequences.  It’s kind of maddening that we are not, if I might be so bold.

 

An unknown consumer law is no law

Under the New York law that administers the troubled, frequently attacked, never amended, industry-drafted Patient Protection and Affordable Care Act, the January termination of my health insurance, by Healthfirst, was overturned by Healthfirst.  

On January 22, 2020 I was informed that my insurance for 2020 had been terminated, without notice, for failure to do something I was also given no notice of.   On January 28, pursuant to my on-line consumer complaint at the New York State Department of Financial Services (where else?)  I had an apologetic call from Healthfirst.  

My insurance had never been terminated, I was told, the supervisor who claimed it had been, and filed the internal appeal I’d lost, had been mistaken when she told me my health insurance had been cancelled.   It had never actually been terminated at all.

Apologies were offered, I beat the poor rep into the ground forcing more and more explicit apologies and admissions out of her.   I paid my premiums through June and lived happily ever after, though I never was able to learn what law had revealed Healthfirst’s “mistake” to it, what law had caused it to overturn an apparently unlawful determination against me.

I have been seeking since to find this law, to cite it by name,  quote its language and set out the requirements for a legal termination of a New York State citizen’s health insurance.  I’d like to help inform my fellow low-income citizens that there are laws in place to protect us from unfair, in fact, illegal, termination of our ACA health insurance and a way to enforce that law and keep our health insurance.   Nobody I have reached in the state government can find the applicable provisions of law for me.  

A law that calls itself the Patient Protection Act (or it used to, before Trump changed the name), while leaving information about key protections unknowable, is useless.  Worse than useless, really, since the legal protection actually exists, only it’s secret — unless some concealed right is accidentally triggered by a lucky individual who files the right hidden complaint.  I will keep searching, apparently it can take a long time to answer certain seemingly straightforward  questions of law and fact.

Just as it will be a while before I can learn what “mistake” resulted in my insurance being irrevocably cancelled again, as I learned yesterday, this time by the government agency that administers the Patient Protection and Affordable Care Act in New York State.  The agency that proudly claims that it is helping all New Yorkers during this public health crisis.

Law, it’s so last century.

 

Death By Corporate Bureaucracy

A cautionary tale about conservative, industry-drafted half-measures to protect all citizens from death due to lack of health care, a human right, particularly in a country as wealthy as ours. [1]  

I had a call from my nephrologist’s office yesterday.   Due to the pandemic, the doctor is doing telephone visits only.   Would I like to keep my appointment for next week?   If so, I’d need to take a blood test two or three days before.   We made the arrangements, since it is a good idea to keep an eye on a potentially fatal kidney disease that seems to be in remission. 

An hour later I got a call from the Insurance Verification Unit of the hospital the doctor works for.   The woman informed me that I came up as uninsured.   As we spoke she ran my Healthfirst ID number again — insurance inactive.   That’s not possible, I told her, I had a hassle with the insurance company in January, but that’s all been straightened out, no gap in coverage, premiums paid through June.   She told me to check with them and call her back with the update, or else I’d have to pay the full uninsured price for blood tests and the telephone visit with the doctor (non-negotiable retail prices nobody can tell you in advance, of course).

I called Healthfirst.   After a rocky first start where I antagonized an agent named Cat by brusquely instructing her to call my doctor’s office and tell them my insurance was in effect, resulting in being placed on hold for fifteen minutes, I called back.   The second rep, a pleasant woman named Annie, responded immediately, in her heavily accented English, to my gentler query.   “No,” she told me within a few seconds, “your insurance was cancelled on March 31.   We didn’t do it.   It was the New York State of Health, you have to re-enroll with them.”

Annie informed me that a month earlier, on March 11, 2020, days before the pandemic epicenter where I live went into lock-down due to the public health emergency, The New York State of Health, sole purveyors of Patient Protection and Affordable Care Act insurance in New York State, sent Healthfirst a notice that my insurance would be cancelled effective March 31, 2020.   No reason was given.  I was paid in full and she could see I’d re-enrolled for 2020 prior to the original December 15 deadline, having done so on December 6.   Annie told me I needed to call New York State of Health and immediately try to re-enroll.

“Why didn’t Healthfirst notify me three weeks before my insurance was cancelled that I’d better get busy if I wanted to remain insured in April, during a pandemic?”

“It was not Healthfirst, it was the New York State of Health, you have to call them, we cannot call them for you,” said Annie, helpfully.   She explained that it was a law, she didn’t know which one, or maybe a policy, that prevented Healthfirst from being able to help me keep the insurance I’d paid them to provide me.  She just knew that, unfortunately, Healthfirst couldn’t do anything to assist me, it was up to me to work it out with The New York State of Health.

I called the New York State of Health Marketplace, the most opaque, overwhelmed and incompetent bureaucracy I have ever encountered (and I spent years dealing with Adult Protective Services and NYCHA two infamous paragons of overwhelmed inefficiency) .   This is what I heard:

Thank you for calling the New York State of Health, for English press “1”

New York State of Health is experiencing high call volume.  Because of the public health emergency we are extending the due date for people who are expected to renew before April 15.   You will receive another notice of the new due date before any changes will be made to your coverage.   You do not need to take any action at this time.  

Also, because of a new federal law, no person who currently has Medicaid coverage will lose their coverage during this emergency.  If you are enrolled in Medicaid and get a notice from New York State of Health telling you that your coverage will end after March 18, 2020, you can disregard this notice.  You will have no gap in coverage.  If you have Medicaid you do not need to report any changes to your account except a permanent address change.

If you need assistance applying for coverage or have a question about your individual marketplace account, press “1”

If you are an in person assister, which includes navigators, brokers, certified application counselors and health plan facilitated enrollers, press “2”.

All other callers, or callers that have pressed one, please continue to go fuck yourself.  After only a few hours on the phone today you will have the opportunity to have a quasi-judicial arbitration of the decision against you that will be decided (probably in your favor) within three or four months [2], possibly more because of the unprecedented public health crisis that is quickly killing thousands .  Please continue to hold.

The next few hours were spent making a lengthy telephone log for Healthfirst, including my recorded, at times learned, lectures on the routine mistreatment of low-income healthcare customers, the incentives for corporations to cull the rolls of people like me, 63, low-income, “takers” who force the insurance company to spend way more than they take in from my premiums.  I described the abolition of the Department of Insurance and the Commissioner of Insurance position back in 2011, when NYS was an early adopter of Obamacare.  I compared the decision to merge oversight of health insurance with regulation of all financial services in New York State to the Supreme Court’s cynical conclusion that since we had a half-black president we were now “post-racial” and since racism is dead there is no need for federal enforcement of the Voting Rights Act Martin Luther King had fought for.   I brought in Justice Tawney’s “no rights that a white person is bound to respect” in the context of the rights of low-income patients protected under secret laws that nobody is entitled to see.  

I described the troll bureaucrat at the NYS Department of Financial Services, the man assigned to locate and send me the citation to the law that had overturned Healthfirst’s illegal termination of my insurance.   He wrote to tell me I had my insurance back so what is my problem?  Why do I even need to know the law Healthfirst had allegedly violated when allegedly illegally terminating my insurance?   He’d research the law I’d asked about when he got the time, but I needed to be patient, it had only been two months– AND WE’RE IN THE MIDDLE OF A PANDEMIC.  No response to my letters to Healthfirst CEO Pat Wang or the office of the NYS Attorney General.

Eventually a sympathetic Healthfirst supervisor named Monique, who I spoke to for perhaps an hour, put me through to “Legal”.   This department, presumably, would at least be able to tell me the law they had reconsidered in reversing the “mistaken” termination of my insurance in January.   By the time Monique patched my call through, of course, their office was closed.  I heard a message about making a request for your records, with an email address I very much wanted to have, but I was too slow to jot it down.   I was told to leave a message and they would call me back.  I have been told numerous lies by Healthfirst in recent weeks, so I am a bit skeptical about this promise being kept, but I left what I hope was a relatively calm-sounding message.  

“They will definitely call you back,” said the optimistic rep I called next, to ask for the direct line to the law department.  Of course, he didn’t have it, or the email contact for them, but he assured me that if you leave them a message they “have to call you back.”   I smiled a bitter smile he could probably hear over the phone, took a breath and told him my recent history with untrue promises from Healthfirst.  I didn’t bother to quote the Arbeit Macht Frei [3] lines from the end of the absurdist word salad I’d received last month from Healthfirst:

Healthfirst takes grievances seriously and wants to assure you that all issues are thoroughly investigated.  Healthfirst sincerely apologizes for the miscommunication and any inconveniences it may have caused you. Our mission is to provide Healthfirst members with high-quality health care. Your satisfaction and well-being is our number one priority.

My best guess as to why an agency all NYS consumers who buy Obamacare health insurance are forced to deal with only once a year at renewal time for everybody, in the hectic days between Thanksgiving and Christmas, would intervene in March to summarily cancel a valid insurance contract between a consumer and a private corporation (making a sham of our vaunted “free market” where business contracts are sacred) is the standard functioning of bureaucracy.

Perhaps when Healthfirst told me they’d cancelled my insurance back in January, before apologizing a few days later for their “mistake”, somebody at Healthfirst — during the two or three business days this mistaken cancellation was in effect — conveyed this erroneous cancellation, as mandated by law,  to The New York State of Health.   True to form, this crack outfit got right on it, irrevocably and without explanation (or notice to the insured) canceling my insurance two months later.

A paranoid thought enters my head in the absence of a rational, or even irrational, explanation:  I’m being retaliated against.   Who is retaliating?  

Perhaps the director of the overwhelmed New York State of Health, a politically adroit woman named Donna Frescatore, a political appointee who has been running the New York State of Health Marketplace since its inception, a public servant to whom I have been unkind, here and in numerous emails, when critiquing her opaque, cumbersome, asshole mechanisms for administering healthcare justice, or correcting the many mistakes made by her overworked, undertrained staff.  

When I asked for her name years ago I was told that it was NYSOH policy not to allow reps to divulge her name or contact information, they’d all been read the order.  Admittedly, they admitted, NYSOH is not a private corporation where such secrecy is routinely guarded, it’s a state agency, a public agency, but still, they had their orders.  At the time public servant Ms. Frescatore, now also in charge of Medicaid in NYS, was difficult to locate.  Not anymore.   Here she is, first google hit:

NY State of Health continues to meet the strong demand for comprehensive, affordable health insurance coverage,” said NY State of Health Executive Director, Donna Frescatore.   Feb 20, 2020

It probably didn’t help matters that I included a few snide, angry, intemperate couplets like this one, toward the close of  my second letter to the CEO of Healthfirst:

A corporate “person” is an appetitive psychopath, without conscience or remorse, driven to devour and only constrained by the rare regulation in place to restrain the gnawing impulse to maximize profits, a corporation’s only legal imperative.  

Of course, this kind of viciously overwrought snideness, defensible or not,  is understandably infuriating and never yields a good result.   Who am I to express such unrestrained anger to the head of a corporation that has already had someone call to apologize verbally for accidentally fucking me?  Who am I to demand to know the law under which my arbitrary denial of health insurance was overturned?   

Who knows who eventually read these words, addressed in an electronic supplement to the Department of Financial Services complaint that forced Healthfirst to overturn it’s final determination that I’d have no health care in 2020 (unless I paid full sticker price for it)?

I am wondering why:

1) there is no notice requirement before a health insurance company can terminate health insurance.  (I had absolutely no notice of the “ten day grace period” they suddenly waived after my DFS complaint)

2) NYSOH Marketplace, sole provider of ACA health plans in NYS, does not inform consumers of the practice of insurance companies abruptly (and “mistakenly”) terminating insurance for failure to pay during a “grace period” nobody is informed of

3) there is no provision in the Patient Protection and Affordable Care Act, or NYS law, that requiress notice of termination policies and fair access to the new NYSDFS complaint process that can force compliance with the law.

Is there someone I can talk to at DFS for more information about these questions?

I was eventually referred to the aforementioned troll.  A few days later I got a letter from the NYSDFS instructing me that since my insurance is a form of pay-as-you-go Medicaid (my income being 167% over the official poverty line) I may not use their handy on-line complaint form, the one that restored my insurance within two business days.  

Because of the low-cost insurance I have, a kind of pay-as-you-go Medicaid created by the ACA, I must wait on line with the rest of the poor people at another state agency, where the newly promoted Donna Frescatore is also deputy director of Medicaid in NY State.   This agency, the New York State Health Department, has no on-line form, or on-line help, or anything else (it’s designed for the poor, after all), but, stay positive and have a nice day, Dude!    

Remember, stress is very bad for your immune system, particularly during a plague!   Please continue to hold, just pretend your life doesn’t depend on it!  

LOL.

 

 

[1]  When the law protecting  low-income patients is designed by the conservative Heritage Foundation, whose mission is to protect the profits of private enterprise, you get more deaths during a health emergency than would generally be considered acceptable in a civilized nation.   The business of America, after all, is business.

[2]  One year I was denied health insurance for three months while I waited for a determination from a NY State of Health arbitrator that the NY State of Health had mistakenly denied me coverage.   Another year it was about six months before the premium subsidy I was entitled to was applied, retroactively, to my account, which I’d been paying full price for pending the decision in my favor.  

[3]   The German words meaning “Work Liberates” were worked in wrought iron on top of the gates to the infamous Nazi death camp where slave laborers for German industry (including Bayer) were worked to death.

 

The Corporate Brain

First thing to understand–  they’ve got the whole world, in their hands.   Corporations.   We live in a global corporatocracy [1], whatever else is also going on.

There are rules we must understand, living under the rule of “persons” accountable only to shareholder profits.  One is to know the kind of “person” a corporation is:  a psychopath — incapable of empathy, remorse, or moral reflection.  The corporate “person” has one legal interest: the bottom line, increasing stock value for its shareholders.   A corporate person will only do the right thing (like paying to remediate its own negligence, or even intentional defiance of existing laws) if targeted by law enforcement and, after exhausting every legal appeal, being ordered to comply by a court of law.   Since corporations spend a fortune on armies of lawyers and lobbyists to influence the drafting of every law that could have an impact on their profits, good luck there, Charlie.

Two is to understand the nature of the corporate brain — it is purposefully segmented into as many unrelated subdivisions as needed to shield the larger organism from harm.  This is a deliberate device to protect the corporation, in part by exhausting the consumer, who must often speak to many unrelated segments of the corporate brain to try to get a reasonable answer, or redress of any kind.  I provide two examples from my recent, ongoing experiences with two random corporations.

Brand new Dell computer does not perform an essential function, seeing my cellphone as a hotspot.   It sees other nearby hotspots and wireless networks, but it cannot find the only network I can use to connect to the internet.  The computer is under warranty so correcting this defect should not be a major problem.   

Except that Dell has compiled a legally unassailable list of specific exemptions from their limited warranty.  They have me run all the diagnostic tests on the brand new computer and, after an hour or so, tell me that there is no problem with the computer’s hardware, and that therefore the problem, which appears to be a software configuration error, is “out of warranty.”   Not to worry, they tell me, Dell has a paid service that can fix the problem for me.

As is typical in corporations, “Warranty” has no way of communicating with “Out of Warranty”, and therefore has no way of informing a customer that 3 years of “out of warranty” service costs $239, plus tax, a more limited version of this “premium” support goes for $169 and a one-time fix will set you back $129.  The customer can only learn these prices after another long wait on hold.   The customer must listen to a loop of ads for wonderful Dell products and services, while waiting to learn the price, and submit to being thanked over and over for how important their business is to Dell.

Enough reason never to deal with this particular corporate motherfucker ever again, but at the same time, Dell is merely on the vanguard of maximizing profits through express warranty limitations.  Corporations can make a lot more money by making customers pay to fix built in problems than by covering their repair for free.  They hire legal geniuses like now-Justice John Roberts, creator of the arbitration clause, to exclude the most expensive repairs, even of Dell’s own design flaws, from the limited warranty.   “What don’t you understand about the word ‘limited’, sir?   All of the limitations are explicitly set forth in the thousands of words of our warranty, which we will send you for free.”

The beauty is, there is nothing you can do.  It’s all legal and ironclad.  Put the computer back in the box, scrawl “FUCK DELL” on top and bring it back to the store.  (I would advise not scrawling “FUCK DELL” on top, it could void the return and force you to pay at least $129 to be able to use the brand new computer).  Caveat emptor, asshole.

Healthfirst, the corporation I pay for health insurance, told me, on January 22, and again on January 24 (after their internal “appeal”), that my insurance had been terminated for my failure to pay a “binder” payment during a once-a-year ten day “grace period.”   They also informed me that under the law they had no obligation to inform me of this “grace period” before terminating my policy.    Then, on January 28, another department in Healthfirst called to tell me that my insurance had never been terminated and apologized for their “mistake.”  

Since then I have been trying to find out what the law actually is.  No state or federal agency has any idea why I was cut off and why I was reinstated.  Nobody can point me to the section of the law that made Healthfirst reverse its unappealable termination.   None can confirm which of the various complaints I submitted resulted in the overturning of Healthfirst’s original determination.

Finding and publicizing the short answer would provide a valuable service for my fellow citizens, screwed by the thousands exactly as I was.   To put it simply: what protections against termination without notice do patients have under the Patient Protection and Affordable Care Act, Obamacare?   You know, the federal law the right wing has been rabidly trying to abolish since it went into effect? [2]

I finally got a letter of explanation from Healthfirst, in an envelope marked “Grievance and Appeals”.  It was entitled “Notice of Grievance Resolution”, as though on February 14 I had contested Healthfirst’s decision to restore my health insurance after terminating it weeks earlier.   The notice states that my insurance was properly terminated for my failure to pay the binder during the ten-day grace period.  It states that my insurance had never been terminated, as confirmed by the call I received on January 28 apologizing for Healthfirst’s “mistake”.

Why this corporate change of “heart”?   That, sir, is nobody’s goddamned business.  Please continue to hold, your business is very important to us.

 

 

[1]  Wikipedia:

Corporatocracy is a recent term used to refer to an economic and political system controlled by corporations or corporate interests. The concept has been used in explanations of bank bailouts, excessive pay for CEOs as well as complaints such as the exploitation of national treasuries, people and natural resources. Wikipedia

[2] The law itself is now finally under reconsideration by the Supreme Court, in light of a federal court striking down the “mandate” that was upheld by one vote when John Roberts found this requirement of Obamacare constitutional.  Keep your helmets on, my fellow hostages.

For the Love of God, America

After a funeral yesterday we all sat in a restaurant having lunch.   The gentle fellow across from me reported how easy it was to deal with Medicare, one simple statement, everything pretty straightforward.   I asked if he thought it a good idea to have a similar health care system for people before they reached sixty-five. He said he did, but how are we going to pay for it?  A second later he began excoriating Sanders and Warren and I saw that we were nearing the end of a real conversation. At this Sanders/Warren prompt there was a chorus of nearby voices stating how imperative it is we vote Trump out in 2020 (that chorus was joined by a Trump 2016 voter.)  

As far as the current health insurance regime for millions, Obamacare, my interlocutor agreed it was absurd to be given a menu without prices and to be billed six weeks later, as the Patient Protection and Affordable Care Act allows providers and insurers to do.

The buffet most of us were having cost $49 per person, as the waitress readily told us.   Imagine if no price was given and our host simply had to wait six to eight weeks to be billed and learn that the price was $400 per person, and there was no recourse.  That’s the price, deadbeat.  If you have premium level buffet insurance, the price will be $49 per person, but, sadly, you did not take precautions.  Caveat emptor, bitches.

On January 8 I had the first of four endovenous ablations in my legs.  It had been deemed medically necessary and insurance had approved the procedures.   There was, of course, no way to know the price in advance, as per the impressively opaque 906 page Patient Protection Act.   On January 22 I was informed by Healthfirst, the company that I pay for my ACA insurance, that my insurance had been terminated.  This meant I’d be responsible for the full, non-insured price of the first treatment, whatever it turned out to be.  Several days later I managed, by very hard, stressful work and sheer luck, to get the unappealable termination of my insurance overturned.   Insurance would pay after all.

My sickening fight with the insurance company, with every state, local and federal agency, the stonewalling at every turn, another story for another day.   It is ongoing and seemingly will never have an end, until I arbitrarily give up.  The citizen has, according to everyone, no right to know the exact provision of the Patient Protection Act that protects him from the unappealable acts of a health insurance company that are later deemed “mistakes” regarding a wrongful termination of insurance.  OK, I guess that’s some form of democracy, if you’re lucky enough not to be violently sodomized by it. [1]

Anyway, the other day I got the Explanation of Benefits for the first of four ablation treatments.   The full, retail price: $5,460.    The Allowed Amount: $1,572.  My copayment, already paid: $25.   Multiply this hefty sum by four and you will understand that the insurance company had thousands of compelling reasons to terminate my policy, if given the chance.   Without insurance, the cauterization of those two leg veins would have cost over $21,000.   That’s why all Americans need health insurance, to be protected against bankruptcy if one survives the medical challenges themselves.

Which is why, of course, Mr. Trump, who promised better, cheaper, universal health care for all Americans back in 2016 has fought so hard to bring us Trumpcare. Cheaper, better, covering all Americans, brought to us all by Mr. Trump (born American and college graduate, unlike Obama!) and the incorruptible, unconquerable wall of Republican Senators and a vast army of lobbyists and “donors”.  USA!   USA!!!

 

 

[1]  I am always pointing out to the reps I am appealing to for help that I support the ACA, voted for Obama twice, realize Obamacare is a halting, but significant, step forward and that the tweaks needed to make it work better — like every other large government program got in its first few years of administration as problems were discovered–  were all prevented by a partisan lynch mob working with a klanlike zeal to prevent the n-word president from having a second term and then making sure he was able to accomplish nothing in his second term but the divisive election of a White Supremacist successor who would do his damnedest to wipe Obama’s record from history.   I get all that, but still.

How To Avoid The Second Civil War

In a nation that has long been an innovator in the inter-related arts of public relations, advertising and propaganda, most of us get our news in a highly mediated, skillfully filtered form that caters, increasingly, to our own personal prejudices.    It seems impossible to find a reasonable consensus at this historically perilous moment.   At least 45% of the country sees Abuse of Power and unprecedented blanket obstruction of all investigations as not impeachable.

Many now believe that there are facts and there are equally valid alternative facts, in this threatening pre-civil war funhouse we are all living in at the moment [1].  We are living in a historically perilous time, like Kansas 1860, or Berlin 1932, with the unsettling overlay of the foreseeable end of a habitable planet ticking loudly in the foreground.   If we are to spare ourselves another actual bloody civil war, followed by mass extinction, we need to be very smart going forward.

We consumer-citizens rely largely on commercial mass media, run by profit-driven corporations with deeply intrenched interests– largely increasing profits — for most of our information about our limited political choices.   Noncommercial news sources like Democracy Now! and the Intercept, outlets that cover the struggles of activists against institutional injustice unreported elsewhere, (and never to my knowledge successfully sued by anyone over a false report), are unknown to most Americans and the news they report is easily dismissed by low information voters and pundits on the right and center as … choose your favorite word for the ranting of liberty-hating, unAmerican losers.

Old friends rage at each other over perceived political dogmatism, blindness, defeatism, stupidity, idiotic idealism, long friendships sometimes ending in bitter inter-partisan disagreement over how to get to the end result both may desire.   Rage is effortless on social media, where trolls reign, delighting in provocation.   

We are sharply drawn into inimical opposing camps, every one of us powerless except as part of a larger block.  As far as political action, we are largely constrained by the design of the two party system, the only game in town, and forced to vote for whichever candidate is chosen for us by a National Committee.  We try to choose the less hateful of the two and hope for the best, a sorry version of actual democratic participation.  

Both major parties run on corporate dollars and the dark money of our super-wealthy, many of them the privileged inheritors of vast fortunes.  Our Supreme Court is staffed by at least five hardcore corporate rights judges who believe that corporations are “persons” entitled to all the freedoms the rest of us enjoy, including the freedom to all the speech their vast money can buy.  Our highest court holds that corporations are citizens just like the rest of us, only with infinitely more power and influence than any thousand of us regular people working together can hope to exert. [2]   The individual, unless very wealthy (see several billionaires currently vying for the presidency) is almost utterly powerless in our democracy.  Except for our freedom to speak, to reason, and to organize.

(brace for a slightly disjointed next paragraph, citizens)

If you are the victim of an illegal practice committed against you by a corporation, join the club, it’s a gigantic one.   Millions of us are fucked by corporations on a daily, hourly basis — they are not in business to make sure consumers are not being fucked, they are in business for the bottom line– maximizing profit, by any means that is not specifically illegal and enforceable against them.  The Supreme Court itself clarified that the sole legal imperative of the American corporation is maximizing profits for shareholders.   If a corporation violates the law, the consumer must find the precise law it violated and then find a legal remedy.  No specific illegal act under law and/or pertinent regulations found, no remedy, stay screwed, asshole.

I was recently victimized by the corporate “person” that provides my health insurance under Obamacare.  On January 22, when I called to pay my premiums through June, I was told Healthfirst could not accept my payment and that my ACA health insurance for 2020 had been terminated.   A supervisor, Daiya by name, confirmed that this had been done “pursuant to the guidelines” for my failure to pay during a once-a-year ten-day “grace period”.   She told me the corporation had no obligation to inform customers in advance of the severe and irreversible consequence of failing to pay within this one-time “grace period”.  She initiated what she said was the only available appeal, an internal one within the company, and called two days later to pleasantly let me know that Healthfirst had not restored my insurance.

Working hard and having a great piece of good luck, I managed to find the only appeal process that could remedy this particular illegal act (at the NYS Department of Financial Services, naturally– here’s the LINK).   Two business days after my on-line complaint I had a call back from Healthfirst, apologizing for its “mistake” and accepting payment of my premiums through June.

Two weeks later, after my letters to the CEO of the corporation and the Attorney General’s office, I had a call from a “Resolution Supervisor” telling me “billing” had asked her to call me.  She assured me that my insurance had never been cancelled.  I was not reassured and questioned this long-suffering, apologetic woman at length.   She told me she’d try to send me the records of my dozen recent calls with Healthfirst, but had to first run it all by another office.

To my surprise, I learned there is an office at Healthfirst called “Regulatory”.  They were reviewing whether I was entitled to call records of my own calls to the private corporation.  I wrote an angry second letter to the CEO, cc’d it to the Attorney General.  I mailed it, then emailed it to her.   The next day I had a call from Healthfirst — I’d be receiving a written apology from Daiya, the confidently “mistaken” supervisor.  I’d get copies of my phone records with dates, times, person I spoke to, the substance of each call.

I am a perversely insistent motherfucker living in a corporately run nation where we non-corporate persons have  very few protections of any kind from routine predatory practices by largely unaccountable entities.   While I was helpless prey I managed to luck onto to a mechanism to almost immediately reverse an extremely stressful interruption of my ongoing medical treatments.   I was fortunate to find someone in an agency, a sympathetic woman who listened carefully, who told me how to get an emailed copy of the sections of the laws that Healthfirst apparently violated in putting me into that upsetting situation.   

I was surprised to learn today that the corporation is giving me everything I asked for without forcing me to bring a lawsuit against them.  I will soon be able to look over the law itself and see which specific sections and subsections were violated in my non-terminal termination.  I am positive than I am the lucky one in a thousand, or ten thousand, maybe a million,  getting almost immediate relief from intolerable, illegal mistreatment by a health care provider, under the Patient Protection and Affordable Care Act.

I am have a certain skill set, I’m diligent and, in this case, my illegally terminated health coverage was saved only by a miraculously fast resolution process that is well-hidden from the average consumer.   We live in a country where the powerful are free to oppress the rest of us, often without consequences to themselves, the burden being heavily upon those fucked to figure out how to unfuck ourselves (not easy, I can tell you for sure).   The laws that exist are co-written by expert lobbyists providing careful loopholes and provisions (like the now ubiquitous “arbitration clause” in every contract — thanks to now-Justice John Roberts, a genius of corporate law) that protect their fantastically powerful clients against things like class actions.

What was done to me, personally, can be multiplied by a hundred, or a thousand, or tens of thousands, just in New York City, where I live.  The woman at the NYC office I spoke to today (NYSDFS) told me they get HUNDREDS of health insurance complaints every day, many similar to mine.   

Do we have vast institutional problems in our country, including opaque laws that allow gigantic unaccountable private profit-driven institutions to do business largely unrestrained by effective laws?   You betcha.    Are many of our government officials, the people we trust to protect our interests, incompetent, lazy, corrupt, complacent or otherwise of little use?   You betcha.   Is the Republican Party, supported by vast funds from our wealthiest and most greedy, going to address this oppression of the many by the few?  Not likely.  (Picture me holding a fortune-telling 8-ball when I ask these questions)   Is the Democratic Party, supported by vast funds from our wealthiest and arguably slightly less greedy, going to address institutional injustice?   Perhaps over the next hundred years, if history is any guide.  If there are still two political parties by then.   If the earth itself is still a habitable place for human life.

We, people of good faith who are living through these viciously partisan times, when even old friends savagely attack each other like angry rats in a failed lab experiment, must find a way forward.    We must talk to each other as reasonably as we can, allow ourselves to hear and consider reasonable arguments. 

We need to meet likeminded strangers, and strategize and organize for effective influence and representation in our Republic. 

We need to act in concert to put pressure on, and keep pressure on, elected officials and the political parties that choose them.    How we do that is a great challenge in our atomized social media surveillance state.   I embrace that challenge as my only alternative to crippling hopelessness, though I have no immediate way forward to report.

I leave you with these wonderful, wise words from historian Howard Zinn, delivered while accepting a prize, toward the end of his life, for his groundbreaking A People’s History of the United States :

I wanted, in writing this book, to awaken a consciousness in my readers, of class conflict, of racial injustice, of sexual inequality and of national arrogance, and I also wanted to bring into light the hidden resistance of the People against the power of the establishment.   

I thought that to omit these acts of resistance, to omit these victories, however limited, by the people of the United States, was to create the idea that power rests only with those who have the guns, who possess the wealth.  I wanted to point out that people who seem to have no power — working people, people of color, women– once they organize and protest and create national movements, they have a power that no government can suppress.

I don’t want to invent victories for people’s movements, but to think that history writing must simply recapitulate the failures that dominate the past is to make historians collaborators in an endless cycle of defeat. 

And if history is to be creative, if it’s to anticipate a possible future without denying the past, it should, I think, emphasize new possibilities by disclosing those hidden episodes of the past when, even if in brief flashes, people showed their ability to resist, to join together, occasionally to win.

I am supposing, or perhaps only hoping, that our future may be found in the past’s fugitive moments of compassion rather than in the solid centuries of warfare.

(you can watch Zinn deliver these short remarks HERE, highly recommended)

 

 

[1]  fact or alternative fact?   From CNN:

The Department of Justice has dropped its criminal investigation into former FBI Deputy Director Andrew McCabe without bringing charges.

Back to me (channeling an alternative fact citer): a president pursuing “groundless” two year DOJ criminal investigations into his personal enemies is not an abuse of power, and even if it was, fuck off you partisan haters!   See Article Two!   It’s the only one you need to read!

[2]  The great Bill Moyers had the best reply to the legal fiction of “corporate personhood.”   He said “I’ll believe that corporations are people when the State of Texas puts one of them to death.”

What to do if your ACA health insurance is illegally terminated

If your insurance company terminates your insurance, claiming you missed a once a year ten-day “grace period”  for payment, go to this site and make an immediate on-line consumer complaint.   The complaint at this agency restored my illegally terminated health care in two business days.   The New York State Department of Financial Services (yeah, I know) now, finally, does the consumer protections functions of the abolished (in 2011) Department of Insurance.  The NYSDFS does what the Attorney General cannot do.  (I know…)

Here are the numbers of two offices in New York City that were enormously helpful while I was trying to have the illegal decision terminating my insurance overturned:

For immediate support, and solid advice during this illegal termination, contact the New York City Human Resources Administration, Department of Health, Public Engagement Unit (212-331-6266  M-Th  9am-8pm  Fri til 6:30).   Alexa at this office urged me to file the NYS Department of Financial Services’s on-line consumer complaint form.  She also assured me, 100%, that the unappealable corporate decision to terminate my insurance without notice would be reversed, which it was.  Bless her.

In addition to excellent and knowledgable support they will direct you to New York City’s new  program, NYC Care.  It  provides an extensive safety net for low-income individuals who lose access to affordable health care.   This wonderful pilot program can save a lot of lives, because it provides for low cost doctor visits long before a too late, ER diagnosis of a fatal stage of a once treatable disease.  This compassionate, life-saving program should be well-known by all New Yorkers and well-publicized until it is.   

NYC Care has a helpline at 646-NYC-CARE (692-2273).  The program is only active in the Bronx, so far, but if you go to any public hospital (Bellvue, Harlem Hospital, Jacobi, Lincoln, Montefiore and others)  you can enroll, at the Financial Planning or Business Office of that hospital, in the low-cost, pay-as-you-go “Options Program”.