Hundreds of thousands of retired New York City employees received incorrect information from Mayor Bill de Blasio’s administration regarding a key provision of a new health plan that the city wants to replace their current insurance with — and, citing a “global paper shortage,” the city is declining to mail out the correct information.
Legal documents show that under the new plan, health care providers will have to get approval in advance from insurance companies before conducting certain doctor’s office visits, mental health care treatments, home health care services, and tests such as bloodwork and x-rays, along with dozens of other procedures or treatments.
But the city mailed enrollment guides falsely saying that these and other treatments would not require pre-approvals to all retirees who will be covered by the new plan.
The episode is the latest in the city’s years-long effort to switch a quarter-million retired city workers and their dependents off their current government-administered Medicare plans and into a privately-run system known as Medicare Advantage.
Retirees’ current plan very rarely requires pre-approvals. But it is common in Medicare Advantage plans, which use it as one of their primary cost-cutting tools.
The issue has been one of retirees’ central concerns for months; during the transition process, they have repeatedly sounded the alarm that approval requirements could place a barrier between them and needed care.
“To wait around for somebody to say, ‘Yes, you can have an MRI; yes, you can go to physical therapy; no, I don’t think you need this test or that test’ — I’m not interested,” Jane Roeder, a retired city administrator, told New York Focus in August.
In a 2020 survey conducted by the American Medical Association, 90% of physicians said that pre-approvals had negatively impacted their patients’ health.
The differences between what was promised by the enrollment guide and what the official document shows is “night and day,” said Steve Cohen, a lawyer representing the NYC Organization of Public Service Retirees, a group currently suing to block the switch.
The vast majority of retirees are unaware of the discrepancy and will decide whether or not to remain the plan on the basis of faulty information, Cohen claimed. (If the switch goes into effect, retirees can pay $191 a month to retain their present coverage, which the city currently provides free of charge.)
“Unless you are a retiree who wants to go through 212 pages of [a] contract and then compare them, you’re not going to know,” he said.
Asked about the incorrect information contained in the guide, a de Blasio spokesperson said, “This plan will provide better benefits for retirees while ensuring the long term stability of the system. We will continue to keep retirees updated.”
The spokesperson declined to answer New York Focus’ questions on what efforts the city had made to inform retirees of the errors.
In a court filing on Tuesday, lawyers for the city acknowledged inaccuracies in the enrollment guide and said that “changes will be made.” But it resisted the call to mail out new enrollment guides, saying that sending out a new version “would be expensive and complex.”
The lawyers cited a “global paper supply shortage” as a reason it would be difficult to mail replacement guides, writing that it would be “impossible” to fulfil an order of such size before February 2022, and estimating the cost at $825,000.
Instead, the lawyers said that the city would make the updated guide available on the Office of Labor Relations’ website and would mail an updated enrollment guide to any retiree who requests one.
As of Thursday, the version of the guide on the Office of Labor Relations website had not been corrected.
Marianna Pizzitola, president of the NYC Organization of Public Service Retirees, said that the city’s solution of updating the website is insufficient. “You can’t expect people in their 80s, 90s, or 100s to be going to the Office of Labor Relations website,” she said.
Implementation of the plan has been on hold since New York civil court Judge Lyle Frank issued a temporary injunction blocking it on October 22. But Judge Frank could lift the injunction as soon as this week—and seemed to be considering doing so during a hearing on Wednesday.
Frank is expected to rule within the next several days on whether to permit the city to implement the plan on February 1, 2022, the date requested by the city’s lawyers. He seemed favorable to many of the city’s arguments, saying at one point that the implementation plan was “starting to sound pretty rational” to him, and floated the possibility of a “tentative approval’ of the plan.
Frank did express some reservations, saying that his “biggest concern” is whether the city has made clear to retirees which health care providers will be included in the plan.
Many retirees have given testimony at hearings or submitted affidavits saying that their doctors have told them that they will not be participating in the plan, or are unaware of it.
At the hearing, the city’s lawyers claimed that many doctors who are contractually obligated to take the plan are unaware of that obligation. Retirees should not necessarily take doctors who say they will not be participating at their word, they argued.
While Mayor Bill de Blasio has been supportive of the switch, Mayor-elect Eric Adams has criticized the plan—which will affect his own health care as an NYPD retiree. The delays in implementation mean that the plan won’t be in effect by the time Adams takes office on January 1, and that the new Adams administration will need to determine whether to continue to pursue the switch.
Pizzitola said that she has reached out to Adams’ team to try to arrange a meeting, but hasn’t received a response. With the CEO of one of the insurers that will be administering the new plan serving on Adams’ transition team, Pizzitola isn’t optimistic that Adams will be sympathetic to her cause.
“If he’s got the CEO of Emblem… on his transition team, but won’t speak to the retirees who this is going to affect, what does that say?” she said.
Eric Adams’ office did not immediately respond to a request for comment.