Poof! And now no insurance

To the editor:

As escalating health care costs spiral, the insurance companies and the hospitals have found another way to “rig the game” against the patient.

Typically, insurance companies negotiate payment rates with hospitals, doctors and pharmacies, who want rates to go up to increase their profits. Insurance companies want to maintain or lower rates to keep more of patient and government premiums, and thus increase their profits.

When negotiations break down, hospitals may refuse to accept patients with coverage from the insurance company, and insurance companies may refuse to pay the bills for patients of that hospital or provider. The patient must either find a new plan that accepts their doctors and that their doctors accept, or accept a new set of doctors in a new plan.

Dr. Elisabeth Rosenthal wrote recently in the Kaiser Family Foundation Health News that “patients can change insurance only during end-of-year enrollment periods, or at the time of ‘qualifying life events,’ such as a divorce or job change. But insurers’ contracts with doctors, hospitals, pharmacy benefit managers and pharmaceutical companies can change abruptly at any time.”

This is legal in New York state!

In 2022, a standoff between Montefiore Hospital and UnitedHealthcare resulted in thousands of patients having to find new primary care physicians and specialists. This year, patients suffered through threats and withdrawn services, because of conflict between Mount Sinai and United Healthcare. 

NewYork-Presbyterian was in a similar feud with Aetna.

The conflicts have been resolved, but in the process, the patients suffered. Please note: If a patient fails to pay his premium for even one month, the insurance company can cut off benefits immediately. One health care advocate’s son failed to make a $20 payment on time and was cut off from a medication he needed to treat severe depression.

He made the payment, but the insurance wasn’t immediately re-instated. Tragically, the son, unable to get the medicine he needed, committed suicide.

There are many insurance plans that promise a 60- or 90-day warning period for major changes to plans. For patients caught in the middle of a course of chemotherapy, for example, some hospitals will appeal for exceptions to the insurance company, and sometimes will prevail.

However, the burden on the patient is unjust.

In New York state, hospitals are licensed as non-profit charitable institutions and relieved of the burden of paying taxes. New York state can require insurance companies and hospitals to continue services to patients at least until the end of the contract term and regulate an exception to the enrollment period for patients caught between contracts.

We can — and should — change the law. Call or write your local Assemblyman and state senator and urge them to pass legislation to provide continuation of coverage to patients impacted during contract disputes between insurance companies and providers.

Helen Meltzer-Krim