Consumer Assistance Programs Help New Yorkers Use Their Health Insurance Once They Have It

Posted March, 27 2014 by Amanda


Kevin Dwyer, client of Community Health Advocates

A couple of weeks ago, we posted about enrollment hitting half a million New Yorkers on NY State of Health. We’re now at over 700,000 New Yorkers according to this week’s press release, 70% of whom were previously uninsured. Nearly one quarter of enrollees are signing up for insurance with the help of an in-person assistor – either a Navigator, a certified application counselor, or a broker – according to the most recent data on how people enroll. This number is likely to grow as more people find out about these services.

In-person assistors, located across the state, are doing phenomenal work helping people to enroll in health insurance plans, but their services are limited to enrollment: What happens after a person enrolls in a plan? The health care system is notoriously difficult to navigate, and consumers will continue to have questions about how to use their new insurance. This will be especially true for the nearly 500,000 New Yorkers who were uninsured before signing up on NY State of Health. Where can these consumers turn when they have a question or run into a problem with their insurance?

Thankfully, New York already has a designated program for this kind of consumer assistance. The program is called Community Health Advocates (CHA), and it’s there to help consumers use their insurance, once they have it. CHA provides services through a toll-free helpline (888-614-5400) and a network of community-based organizations and small-business organizations throughout the state of New York. The CHA helpline number is listed on every Explanation of Benefits from every insurance company in the state. And, since it became the state’s designated consumer assistance program in 2010, CHA advocates have tackled over 162,000 cases like this one and saved consumers over $12 million in health care costs.

CHA services can make a life or death difference in people’s lives. They likely did for Kevin Dwyer (pictured above). When Kevin’s insurance plan denied his request for a new, promising drug for his cystic fibrosis, because it had not been FDA-approved for his particular genetic mutation, he contacted CHA. His case was particularly surprising – and frustrating – because his sister, who has the same disease, genetic mutation, physician, and health plan – had gotten approval using the same approval. With the help of CHA advocates, Kevin was able to get the treatment he desperately needed. In his words, “With CHA, you’ve got somebody.”

HCFANY is actively advocating for sustainable funding for these important services. They are desperately needed, particularly now with so many newly insured New Yorkers. This year’s Executive Budget from Governor Cuomo and the Assembly’s budget proposal both include funding for Community Health Advocates – authorizing a pass-through of $2.5 million of federal funds to go to the program. However, the Senate bill has not yet agreed to authorize the funding, which is surprising given the positive impacts of the program and the fact that there are no state funds involved. HCFANY members and other organizations continue to work to ensure that this vital resource is supported in the final budget, which is set to be enacted by April 1.

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