Since passage of the Affordable Care Act, New York State has cut its uninsured rate in half from 10% to only 5% through the successful implementation of the New York State of Health Marketplace and investment in local Navigator organizations who provide in-person enrollment assistance to hard-to-reach communities.
Yet, for many New Yorkers having an insurance card has not translated into better access to care because of the incredibly complex and confusing rules governing their insurance policies and affordability issues.
They often do not have the benefit of a workplace “HR” department to assist them when a problem arises with their health insurance.
New Yorkers need help understanding and using their health insurance
A 2014 Kaiser Family Foundation survey of thousands of Navigator/Assistor programs found that 80% reported that enrollees returned for additional, post-enrollment insurance assistance. Navigators in New York corroborate that they see high numbers of returning clients who, after successfully enrolling, seek additional help with issues such as finding in-network providers, requesting plan cards, resolving billing issues, or understanding communications from their plans. Both the newly covered and those who have been covered for years need help understanding insurance concepts like deductibles, co-payments, co-insurance, maximum out-of-pocket costs; and filing complaints and appealing plan decisions.
New Yorkers are having trouble paying for care.
Insurance company and medical billing practices often leave consumers vulnerable to medical bills that can wreak financial havoc in their lives. According to a survey conducted by The New York Times and the Kaiser Family Foundation in 2016, 62 % of people with medical bill problems had insurance. And in a 2019 survey of New York health consumers, 52% said they struggled paying for healthcare within the past year.
More funding is needed for post-enrollment assistance
Community Health Advocates (CHA), the state’s Consumer Assistance Program, helps 30,000 New Yorkers every year navigate the healthcare system and their insurance through a central live-answer, toll-free helpline and a network of 30 community-based organizations and small business serving groups serving all 62 counties of New York. The helpline serves approximately 10,000 callers each year and handles complex commercial insurance coverage appeals of denials of care and payment of medical bills. The program has saved New Yorkers $35 million to date in health insurance and healthcare related costs.
CHA’s helpline is listed on all commercial insurance carriers’ Explanations of Benefits and claim denials. But CHA’s helpline number is not listed on Medicaid Managed Care notices when a benefit is denied. This means that there are currently more than 4 million low-income New Yorkers enrolled in Medicaid Managed Care plans who may not find out about CHA’s services when they most need them.
CHA is currently funded at $3.9 million by the New York State Legislature and the New York State Department of Health.
But CHA needs a total of $6.5 million to adequately serve the needs of all New Yorkers, including Medicaid enrollees who may need help understanding their Medicaid notices and appealing claim denials.