State audit causes chaos for dependent health insurance, PEF comes through for members
By DEBORAH A. MILES
Imagine taking your child to see a doctor, and being told by a person at the registration desk that your child has been dropped from your health insurance.
That is what occurred to two PEF members who were shocked and in disbelief that this was happening to them.
Carol Guarino, a dietitian at Helen Hayes Hospital, got the news a week before Christmas when she was taking her son, who has type 1 diabetes, to see a new doctor.
“When I called the insurance company, I was told it has something to do with your Human Resources Department. Phone tags followed, but when I finally reached HR, they told me about an audit conducted by the state Department of Civil Service to verify that dependents in the New York State Health Insurance Program met eligibility requirements. The state never received my papers. What was worse, the cancellation was retroactive to January 1, 2016. During that year, my son had been in the Intensive Care Unit for two days and another time at the Emergency Room. I kept thinking about these bills I would receive and how it would be financially devastating.
“I called people to try to get help or answers, but they just shrugged their shoulders and said, ‘I don’t know what to tell you,’” Guarino said.
Tiffany Infantes, a senior unemployment insurance hearing representative at the state Labor Department, encountered a similar situation. She was told a mass mailing went out to notify policy holders of the audit to verify dependents on the insurance policy. Infantes did not receive a notice and discovered that her daughter’s coverage was inactive when she took her to the doctor.
“No one from the Civil Service contacted me in any way,” Infantes said. “I tried dealing with Civil Service on my own, asked for an appeal, and ultimately it was denied.”
For both women, the next step was to see if PEF could help.
Infantes credited assistant council leader Michelle Maldonado, field representative Robert Wright and PEF health benefits specialist Lorraine Simpkins.
Simpkins said PEF’s Contract Administration Department contacted Civil Service and the Governor’s Office of Employee Relations and informed them that the state appeared to be in violation of the federal Patient Protection and Affordable Care Act, and to reinstate the coverage for these members, or PEF would take action.
Civil Service responded in early February and said it would reinstate the coverage of Guarino’s and Infantes’ children retroactive to January 1, 2016, saving both members repayment of claims and IRS penalties.
“I was hitting dead ends when I was advocating for myself,” Infantes said. “I don’t know how PEF got Civil Service to change its decision, but I am endlessly grateful for it. It feels like a miracle.”
Guarino said she never utilized the union before this happened, and was thankful to be a PEF member.
“I would definitely encourage people to join PEF and support it,” Guarino said. “In the end, it is your union that supports you.”
THeCOMMUNICATOR – March 2017 Contents – PDF