UPDATE: NEW YORK: Latest Health Republic Co-Op developments not exactly confidence-building

I wrote a couple of posts last week about the ongoing Health Republic of New York Co-Op meltdown, which has quickly gone from being just-another-Co-Op-closure to a complete disaster for up to 166,000 New York residents, primarily because unlike the other Co-Ops which are at least covering their existing enrollees through the end of December, Health Republic is now having the plug pulled out at the end of November, which gives current enrollees just 8 days to scramble to find new coverage for the last month of 2015.

This was made worse by the fact that the November 30 cut-off wasn't even announced until October 30, and even then, the powers that be in the NY Dept. of Insurance, NY State of Health exchange and Health Republic itself didn't appear to treat this development with any particular sense of urgency. I mean yes, they posted notices about it and supposedly sent out letters to all 166,000 people, but an awful lot of those people didn't appear to have received those notices as of a few days ago. Hell, until a day or two ago the NY State of Health website didn't even have anything posted about the 11/30 cut-off at all.

Well, I've been screaming bloody murder about the situation, as have others, and it seems to be getting some butts moving...but I'm not sure how helpful any of it will be.

First up: Dan Goldberg, a very good reporter for Politico New York, posted a big story about the mess on Thursday which no doubt forced some action:

The announcing triggered concern among its customers, who aren't sure what to do next, and among other health insurers, now worried over the prospective unraveling of what had been a model of a functioning state health care exchange.

The Department of Financial Services, in a press release, instructed Health Republic's 200,000 customers to choose a new plan from the state-based exchange by Nov. 15 if they wanted health insurance in December.

But no one appears to have checked with New York's other insurers, who are wondering how they will handle the logistics of enrolling a population for which they had not planned.

The problems are numerous: First, other health insurers have no way to identify whether Health Republic's customers met their 2015 deductible, or how far they are toward the out-of-pocket maximums put in place by the Affordable Care Act.

...And all of this is happening as DFS, the department responsible for regulating insurance, undergoes a leadership change. Superintendent Ben Lawsky, who ran the department since its creation four years ago, left in June. His replacement, Anthony Albanese, has already announced his resignation because he could not work with the Cuomo administration.

Making matters even more complicated is that many Health Republic customers seem to have little idea of what is going on. The insurer, which lost $130 million during its first 18 months and borrowed more than a quarter-billion dollars from the federal government, says it is sending out letters to all its members.

But many have yet to receive that letter, which means thousands of people will have less than 10 days to pick a new plan if they want health insurance in December.

Those who have received the letter and head to the state website find prompts telling them to return on Nov. 16, a day too late.

On Facebook, Twitter, Medium and other social networks, members have been expressing their confusion and outrage, lashing out at both Health Republic and the state for putting them in this position.

The consequences can be devastating. Health Republic was the only insurer on the exchange to contract with Memorial Sloan-Kettering.

Ideally, a story like this would cause the powers that be to try working together to solve the problem, and perhaps some of that is happening. However, according to Goldberg's follow-up story, the main response so far appears to be finger-pointing by various authorities trying to avoid being blamed for the mess:

Governor Andrew Cuomo on Thursday night sought to share responsibility for a key New York health co-op with the federal government, hours after a Republican congressman and possible challenger blamed the governor for not being more engaged.

Cuomo, speaking in Puerto Rico, said the state had been working "hand in glove" with the Centers for Medicare and Medicaid Services to unwind Health Republic of New York and transition its more than 200,000 customers — 20 percent of the individual market in the state — to a new carrier in the next nine days.

(Note: The original number was 200K, but effectuated enrollment was down to 166K as of a few months ago). NOTE: SEE IMPORTANT UPDATE BELOW.

But even as Cuomo sought to distance himself from the biggest disaster to hit New York's otherwise functional state health exchange, other officials began to raise questions about whether the state should have seen it coming and should be doing more to help.

Some of the criticism came from Rep. Chris Gibson, a Republican congressman who is positioning himself for a run for governor. He called on Thursday for an independent investigation of the state Department of Financial Services, and suggested state regulators missed the warning signs.

..."What remains to be known is whether this was a result of incompetence or dishonesty on Health Republic's part, or negligence on the part of DFS," he said in an email. "Regardless, this happened on Governor Cuomo's watch and New Yorkers deserve an independent investigation to get to the bottom of this."

Earlier this week, Rep. Sean Patrick Maloney, a Democrat, also called for an independent investigation, and said he planned to write the state health commissioner and U.S. Secretary of Health and Human Services.

OK, so enough of the blame game; there'll be plenty of time for investigations after the dust settls; right now, the most important thing is to get those people covered, right? Well...

...That's created a panic among consumers, who have until Nov. 15 to find a new plan if they want to remain insured in December.

State Senator Kemp Hannon, chair of the health committee, said there will time for finger-pointing later. The issue now is helping the 200,000 people about to lose coverage find some place to enroll.

"There needs to be an urgent, clear and concerted effort to take care of these folks who won’t have insurance," Hannon said. "That hasn't happened."

Anderson said the state and Health Republic are sending out letters and emails to beneficiaries.

The first set of electronic notices went out Friday, he said, and the first round of paper notices to Health Republic customers went out Saturday. There will also be additional reminder notices to follow the initial notices over the next few days, he added.

Holy Fucking Shit. They're just sending the emails and letters out NOW??

Today is Saturday, November 7th. The official deadline is November 15th, just 8 days from now. The 11/30 cut-off was announced on October 30th. Why the hell weren't people notified by email, letter and phone calls starting 8 days ago???

UPDATE: OK, I've been informed by Matt Anderson, the Deputy Superintendent for Public Affairs for the NY Dept. of FInancial Services that "Friday" and "Saturday" refer to last week after all, so my apologies for that misunderstanding.

Anyway, let's see what's happened in the past day or so:

Well, the NY State of Health website has finally posted something on the home page of their site:

...and they've finally posted an update in their News section, although it's just a link to a PDF, and even the PDF isn't particularly helpful beyond giving the basics of the situation in a FAQ format:

Frequently Asked Questions – Health Republic Coverage Ends November 30, 2015

Q. I was previously notified that my Health Republic coverage would end on December 31, 2015. Is this a change?

A. Yes, this is a change. Your Health Republic coverage will end one month earlier on November 30, 2015.

Q. How do I select a new health plan?

A. You can:

  • Log in to your Marketplace account before November 16th and visit the “Plans” tab at the top of the screen.
  • Select “Find a New Plan” at the bottom of the screen to see your health plan options.
  • Once you have chosen your plan, be sure to select “confirm and checkout” to confirm your enrollment in your new plan for December 1, 2015 coverage. You can also call our special customer service helpline for Health Republic members at 1-855- 329-8899 and our customer service representatives will help you select a new plan or give you contact information for an in-person assistor in your area who can help you.

Q. What should I consider when I select my new plan?

A. You should consider:

  • Whether your health care providers are in the new health plan’s network.
  • Whether the prescription drugs you take are covered by the new plan.
  • The premium cost of the new plan. To find contact information for the health plans offered on NY State of Health and links to each health plan’s provider network directory visit (link)

Q. Do I have to select the same metal tier (platinum, gold, silver, bronze) as my Health Republic plan?

A. No. You can select any health plan that is available in your area at any metal tier.

Q. What happens if I don’t select a plan by November 15?

A. In order to ensure you are covered during the month of December 2015 you must pick a new plan before November 16, 2015. If you do not select a new plan before November 16th, you may not have health insurance coverage for December.

Q. Do I still have coverage for the month of November?

A. If you paid your Health Republic premium for November, you have coverage.

Q. What if I already paid my Health Republic premium for December? Do I have coverage for December?

A. No. Health Republic will no longer offer coverage after November 30, 2015. If you already paid your monthly premium, it will be refunded to you by Health Republic.

Q. What if I have already met or have paid towards my deductible in my current plan?

A. If you are enrolled in a Health Republic plan that has an annual deductible, the NYS Department of Financial Services is working to ensure that your new health plan will not charge you for the amount of deductible you already met in 2015. Keep your records. You may need to provide your new plan with evidence that you have met all or part of the 2015 deductible.

Q. Will my providers be in my new plans’ network?

A. You should ask both your providers and the plan you are considering joining about whether your providers participate with the new plan. To find contact information for your health plan and a link to the plan’s provider network directory visit at: http://info.nystateofhealth.ny.gov/PlanCustomerService

Q. What if I am receiving treatment when my Health Republic coverage ends on November 30, 2015 and my provider is not in the new plan’s network?

A. If you are either: a) in an ongoing course of treatment with a provider for a life-threatening or a degenerative and disabling condition or disease, or b) in the second or third trimester of a pregnancy when your new coverage becomes effective on December 1, 2015, then you may be able to continue to receive care from your provider for up to 60 days (or through pregnancy) under your new health insurance policy, even if your provider does not participate in your new health insurer’s network.

To receive transitional care, your provider must agree to accept as payment your new health plan’s reimbursement for such services and to certain other conditions of providing care under the new policy. If your provider agrees, you will receive the services as if they were being provided by a participating provider. You will only pay for any applicable in-network costsharing. You, your representative or your provider should contact your new health insurer to determine if you are eligible for transitional care.

To request transitional care, call your new health plan’s customer service and let them know that you are new the plan and ask how to request transitional care. If you experience any problems with the process, you can call the NYS Department of Financial Services toll free number 1-800-332-3736 for assistance in filing this request with your health plan.

Q. What should I do if I have scheduled procedures or medical care in December 2015?

A. If you have care scheduled during the month of December 2105, you should do the following:

  • Visit the NY State of Health website, call the NY State of Health Customer Service Center at 1-855-329-8899 or visit an in-person assistor to review your plan options.
  • Ask your provider which health plans they participate with.
  • Select your health plan.
  • Call your new plan’s customer service to tell them that you have scheduled procedures or care in December 2015 and ask if you need prior-authorization.

Q. If I select a plan for December 1, 2015 will I be automatically enrolled into that plan for January 2016 or do I need to make a separate plan selection for January coverage?

A. You will need to return to the Marketplace beginning on November 16 to select a plan with an effective date of January 1, 2016. You can view your 2016 plan options now, which can help inform and expedite your 2016 enrollment when you return to the Marketplace after November 16.

There's a pretty obvious solution here, it seems to me: Extend the deadline for Health Republic NY enrollees to sign up for December coverage until the end of November. The problem is that I have no idea whether that can be done legally. During both the 2014 and 2015 Open Enrollment periods, the enrollment deadline was bumped out multiple times at both the federal and state exchange levels to give people more time to sign up, so I don't see why that would be an issue here, but there may be specific legal ramifications/restrictions in New York which I'm not aware of. It's possible that all of the individual insurance carriers would have to voluntarily agree to such an extension; I really don't know if it can be forced upon them.

Anyway it's a fucking mess.

UPDATE: I've discussed some of this with both reporter Dan Goldberg and NY DFS employee Matt Anderson (both noted above) a bit this morning; it seems like a good idea to clarify a couple of key points:

  • FIRST, regarding the current enrollment total: Most of the articles about the Health Republic situation have been throwing around "200,000 poeple", while I've been assuming around 166,000 (87K in individual policies, 79K in small group policies), based on the official NY DFS approved premium rate filing report from July. HOWEVER, I don't know what date that 166K was effective as of, so it's entirely possible that it has increased since then. In addition, while individual policies are mostly limited to open enrollment, small group (SHOP) enrollment is available year-round, so it's possible that 30K or so more have been added to that side. In other words, 200K could be the correct current number after all.

I don't know who's to blame for this. It could be the management of the about-to-be-defunct Health Republic of NY CO-OP. It could be someone at the NY State of Health ACA exchange. It could be someone at the NY Dept. of Financial Services. Perhaps it's all three.

I want to re-emphasize this point. I don't really know which of the three (Health Republic, NYSoH or NY DFS) is in charge here; it's possible that only one of them is allowed to decide when notices get sent out, how they're sent/worded and so on. Of the three, I'd imagine that it's the Dept. of Financial Services who'd be most likely to be running the show (obviously the Co-Op isn't in any position to order the other two organizations around), but who the heck knows?

Finally, this part from Goldberg's first article caught my eye:

The problems are numerous: First, other health insurers have no way to identify whether Health Republic's customers met their 2015 deductible, or how far they are toward the out-of-pocket maximums put in place by the Affordable Care Act.

"In addition to the administrative difficulty of just doing this calculation, plans are uncertain how the credits will be based — i.e., solely on official documentation (such as an Explanation of Benefits) from Health Republic, or some other method — and how the information will be verified," Leslie Moran, spokeswoman for the New York Health Plan Association, said in an email.

Moran wants the state to verify all this information — a gargantuan task to undertake in three weeks. 

I don't work for an insurance carrier, so I don't want to presume how difficult this information would be to compile, but it feels off to me. If any actuaries and/or insurance company employees (especially those in the billing or data management department) are in a position to offer an opinion about it, please feel free to contact me. Insurance companies seem to maintain precise data on every dime that's owed to them, so I find it difficult to believe that they don't maintain up-to-date records on just how much current enrollees still owe towards out of pocket charges.