Gov.: State To Make Good On Enrollment Issues
Gov. Andrew M. Cuomo announced Sunday, Feb. 9, that thousands of consumers who faced enrollment problems and other issues after signing up for health insurance with Empire Blue Cross Blue Shield (“Empire”) will receive three weeks of free coverage.
The agreement follows a Department of Financial Services (DFS) probe into complaints about Empire sending out member ID cards late, failing to send out bills on time, and other issues.
“Empire did the right thing by working to address these issues and delivering relief to consumers,” Cuomo said. “We will continue to work vigilantly to ensure that consumers receive the high standards of care and service that they deserve from their insurance companies.”
Benjamin M. Lawsky, Superintendent of Financial Services, added: “We acted swiftly to investigate these problems and work with Empire to correct them. We’re pleased that the company stepped up to acknowledge the issue and move to make progress toward fixing it.”
On Jan. 9, the DFS wrote to Empire urging that they take immediate action to rectify complaints about enrollment problems among consumers signing up for coverage through the New York State of Health (NYSOH) marketplace. Among the issues that DFS identified included:
– Failure to Send Premium Bills and ID Cards on a Timely Basis. Many newly enrolled customers complained that Empire either failed to send premium bills, or else failed to send bills in a timely fashion. Furthermore, some newly enrolled consumers complained that they had not received member identification cards from Empire.
– Failure to Ensure that Enrollees are Properly Transferred into Appropriate Plans. Consumers complained that Empire had no mechanism for transferring direct pay enrollees into new coverage.
– Failure to Timely Answer or Handle Telephone Inquiries. DFS received reports that Empire was not answering calls from consumers and, in other instances, subjecting callers to unreasonably long wait times.
In recognition of these and other challenges faced by their policyholders, Empire has agreed to provide three weeks of free coverage to consumers who enrolled through NYSOH and paid for coverage for the month of January, but did receive care during that period. Those consumers will receive cash payments equivalent to three weeks of premiums paid. An estimated total of 15,000-20,000 Empire consumers are expected to receive this relief. Under the agreement, Empire has also committed $2 million to consumer education to encourage enrollment of the uninsured and others in health care coverage through NYSOH.
The DFS will continue to monitor Empire’s implementation of new enrollment and compliance with this agreement.
Consumers who wish to file a complaint about Empire or another insurer can call can contact the DFS Consumer Hotline at 1-212-480-6400 or 1-800-342-3736 for assistance.
