One Year Later: Health Republic Affordable Care Act Health Insurance Has Failed Me.

My name is Liz Jackson. I’m a 33 year old New Yorker. I have a chronic neuromuscular condition. And I have doctors. Lots of doctors. Who need to be paid. I am writing this post because I don’t know what to do to ensure my doctors will get paid. The issue is my health insurance. I selected Health Republic from the New York State marketplace. And they haven’t been living up to their end of the bargain. This post is a plea for help. Do you have resources? Do you have advice? Are you the Attorney General? My doctors have sacrificed so much for me. They need to be paid. And they deserve to know why they haven’t been.

Other things you may want to know. I’m smart. I’m resilient. I am well educated. I am persistent. Seriously, I am PERSISTENT. I’m a vocal supporter of the Affordable Care Act. And a year ago, I wrote an enthusiastic and optimistic post titled 15 Days On The Obamacare Marketplace. Since then, I have failed to successfully navigate the Health Republic NY Silver plan I selected.

So if I, an intelligent 33 year old, college educated, persistent adult with time and access cannot navigate my Affordable Care Act health insurance… who can?

This is a list of email correspondences I have had with Health Republic NY. There are over 100 emails. This doesn’t take into account the calls I have made to both Health Republic, NY State of Health, Community Health Advocates and The Attorney General’s Office.

3/7/14 Spoke with Representative prior to signing up about long term continuation of coverage with an out of network doctor. She provided me with an Access to Care and Transitional Out of Network Referral Form.

4/23/14 I submitted the Access to Care form prior to start date. I cited recommendations by Kathleen Sebelius about continuation of coverage. I inquired about the process to submit and review.

4/24/14 I am notified that my Health Insurance had an effective start date of 4/1/14, even though I was covered by employee health insurance until the end of April. This requires 6 phone calls to Health Republic and NY State of Health before the situation is resolved. It took hours.

5/1/14 I’m now covered under a Health Republic NY Silver Plan

9/2014 Health Republic has not paid for May for my Out of Network doctor (who will now be referred to as OND), even though I was informed the doctor would be covered as in network per my request on 4/23/14.

9/26/14 I was told claims were paid.

10/10/14 My OND still has not received payment.

10/20/14: My OND receives payment from Health Republic in the form of a Credit Card. Seriously.

11/6/14 I can’t find an in network dermatologist, I call every dermatologist within 30 minutes, and each of them have dropped Health Republic, citing discomfort with coverage. I have to go past New York State’s 30 Minute 30 Mile law to see a doctor for a rosacea flare up. I asked Health Republic to update their dermatologists and they weren’t willing to do this.

I tell this to Health Republic:

“There is the exception of [redacted] Dermatology P.C. but their reviews online consist of rudeness, pain, aggressiveness, and a mean staff.”

11/5/14 I was notified that my approval for my OND was only for 90 days. I specifically had asked prior to joining Health Republic for no end date on continuation of coverage, citing a chronic illness. Health Republic said they made OND aware of this 90 day condition. OND was not made aware. I send Health Republic a copy of what OND received.

12/15/14 Health Republic says in writing they will give me until Feb of 2015 and then stop OND’s coverage. But an hour prior I had recorded a call where I was told they were going to give me limitless coverage. They acquiesce. OND is now covered. I receive a letter in writing.

12/18/14 There’s a billing Issue. I just logged onto Health Republic to pay my bill and it went from $114 to $2127. Takes months to resolve billing issue.

1/22/15 I inquire as to why OND hasn’t been paid since we received letter of ongoing coverage.

1/25/15 Was told claims were in process.

2/5/15 OND still hasn’t received payment for October November December or January

2/6/15 I’m told claims were incorrectly declined, resubmit.

2/23/15 OND still hasn’t received payment

3/2/15 Claims denied again in error — for October 2014 moving forward

3/15/15 Billing issue with Primary Care (In Network) I keep getting charged $15 when I think copay should be $0 My card has two Co-Pay’s listed:

Primary Physician Co-Pay — $0
Primary Care Co-Pay — $15

I had assumed that since my doctor was my primary care physician, there would be no co-pay. I was wrong. I now owe $15 for every primary care visit since 5/1/2014

3/16/15 OND receives request for doctors notes. OND believes the request is illegal. Still hasn’t been paid. Health Republic tells me the request for doctors notes was an error. OND won’t see me again until she’s paid. I tweet to every member of Health Republic’s board.

3/18/15 OND gets paid for October November December and January

4/14/15 I inquire about February as OND hasn’t been paid. I am told my contact at Health Republic (who I was comfortable communicating with) was no longer in the dept and will no longer help me.

4/22/15 New Health Republic rep writes to say claims for February are still in process. I respond with a series of questions, explaining how the last time my OND’s claims were in process they were incorrectly denied. I also ask a series of questions, most notably the fairness of advertising a benefit like acupuncture on the marketplace when Health Republic pays only 9% ($8) of the bill.

5/6/15 I write old rep saying new rep hasn’t answered any of my questions.

5/11/15 I write every Health Republic email I have. This is what I say:

“I wrote 27 days ago with a series of questions and still have no response. [New Rep], if you are not able to assist me in the manner that [Old Rep] was able, will you please forward my information to someone who can?

This is 3 months after the last fiasco and I was promised this would not happen again. My doctor has not been paid since January and she is growing impatient. I was happy working with [Old Rep], I need a solution that prevents this from continuing to happen.”

5/11/15 Again I’m told claims for Feb and March are still in process. I ask for clarification.

5/13/15 I receive claim numbers for finalized claims. No details on when checks will be sent. I also learn that my Out of Pocket is not $1,000 as I thought but $4,500. And my deductible is not $0 as I thought but $2,000. I scour my records for proof, realize none was ever sent by NY State of Health or Health Republic. There’s no record of what I signed up for. How can I be expected to trust Health Republic’s word?

5/19/15 NY State of Health informs me they’re not able to access the information for what I signed up for. I contact the Attorney Generals Office. Health Republic offers to make a call to NY State of Health with me. I decide to hold off and wait for AG’s office.

5/20/15 Speak with an advocate at the AG’s office

5/21/15 discover my monthly Health Republic payment has gone up (again) from $119.16 a month to $2,080.16. I also receive a letter saying I’m maxed out on benefits for Acupuncture (this is an in-network Acupuncturist, and Health Republic rejected every claim she submitted). I start this list. I will be updating.

Currently, I have not had anyone speak with me about
- Whether OND’s check has been mailed
- Why my benefits are so low on acupuncture (when it is advertised on the marketplace as a benefit)
- Why I’m maxed out on benefits on acupuncture
- How I can get my OND paid on time
- How to get my payment back down to $119.16
- What could have possibly happened to cause such a disconnect between what I thought my out of network/deductible were and what Health Republic tells me they are. Why is there no proof.
- And who my dedicated health republic representative will be.

I have written emails begging (BEGGING) for help, for an advocate, for someone to dedicate a few hours of their time. I have begged dozens of times. There’s no asking I can do to get their attention. I have spoken with various representatives within Health Republic (including the Corporate level) and nothing works.

My OND is someone who previously would have considered carrying an Affordable Care Act insurance. But I can’t imagine she would ever consider it now, not after the blind eye Health Republic has turned to her. I will reiterate, she still hasn’t been paid for February, March or April. It suddenly seems so obvious why there are no in network dermatologists within 30 minutes of my NYC home.

So again I must ask. If I, a college educated, persistent, adult who is aware of my rights cannot navigate Health Republic’s marketplace insurance… who (WHO!) can?

One Final Note: I am also a trained healthcare advocate.