Health Republic Failure Creates Burden For Both NY Patients, Medical Providers

HAUPPAUGE, N.Y. (CBSNewYork) — Many people are still scrambling to change their health insurance after a major insurer, Health Republic, went belly up.

Many have switched to the new basic essentials plan being offered through the New York state health exchange, but the failure of Health Republic is having some major consequences for the medical providers, too.

Kevin Dahill, president and CEO of the Nassau-Suffolk Hospital Council, said his group is trying to make sure doctors and hospitals are not stiffed on at least $100 million owed to them by Health Republic.

“There are a lot of outstanding claims at the hospitals,” Dahill told TV 10/55’s Richard Rose on Sunday’s “Exit 10/55.”

Dahill said around mid-summer payments from Health Republic stopped coming in. The state announced in early September it wanted the company to cease operations, which took effect Nov. 30 and impacted about 200,000 people.

The move put both patients and providers in a bind.

“A number of these people are sick and undergoing treatment. Many of them are pregnant. So there was no way their treatment could be ceased,” Dahill said. “So the hospitals and the doctors had to continue to take care of them, but at that point were on notice that there was no insurance coverage.”

Dahill said Health Republic was different because it was a federal co-op plan formed as a result of the Affordable Care Act. He said 23 such co-ops were created nationwide and 14 have failed.

“Politics … took over in this case,” Dahill said. “What happened was these federal co-ops were funded upfront by the federal government. They were given reassurances that as their enrollment grew, as utilization grew, there would be a further infusion of money. And that never happened. And it didn’t happen because of the politics in Washington.”

Health Republic told Newsday its financial problems were “created largely by the risk corridor program only paying out 12.6 percent of the $149 million Health Republic was owed for 2014.”

Dahill said his group is making sure people are still receiving treatment. Some are being automatically enrolled in the essentials plan, but many are complaining they can’t see their regular doctors under that plan.

The Health Republic failure means many people will have to pay higher premiums or seek subsidies to help with the cost.

 

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