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  www.communityhealthadvocates.org Community Health Advocates TheConsumer Voice for Health Care Access 2014 Annual Report
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  Community Health Advocates CommunityHealth Advocates (CHA) helps New Yorkers navigate the complex health care system by providing individual assistance and public outreach and education to communities throughout New York State. CHA is an “all-payor” program, providing one-stop service to consumers with private or public coverage, or no coverage at all. We helps consumers and small employers learn about the Affordable Care Act, understand health insurance coverage, and access the health care they need. One-on-One Assistance: We are a network of community-based organizations and small business-serving groups, and a live-answer helpline where New Yorkers can get one-on-one, free, unbiased information and assistance. Consumer Education: We conduct community presentations about different health insurance topics for health care consumers, advocates, small employers, and providers about health insurance programs. Community Empowerment: We develop the capacity at community-based organizations to address local health access needs through ongoing trainings, direct assistance to consumers and small business employers, technical assistance, and program quality assurance. Policy Feedback Loop: We provide critical, real-time feedback about issues and trends related to health insurance and access to health care. We serve as the eyes and ears of communities for state policy makers. We offer: A trusted ally in a complex landscape
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  www.communityhealthadvocates.org Community Health Advocates(CHA) was designated as New York State’s health care consumer assistance program in 2010. Since then, CHA has helped nearly 200,000 consumers obtain health care services, understand their health insurance, and make health care work for them. The CHA program has been lauded nationally as a leading model of a consumer assistance program by the Kaiser Family Foundation, the National Governor’s Association, Families USA, and U.S. Department of Health & Human Services. We completed 17,956 cases for New Yorkers. In 2014: We answered 8,505 calls through our live-answer helpline. We provided health insurance information and assistance to 4,387 small businesses and their employees. We saved New Yorkers $1.3 million in health-related costs. 39% 12% of CHA clients live Upstate of CHA clients live in NYC of CHA clients live in Long Island 49% 59% 68% 87% 40% are between 27 – 64 years old have an annual income of $25,000 or less have health insurance are racial/ethnic minorities
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  Community Health Advocates Makinghealth insurance work for New Yorkers • Use their health insurance • Resolve medical billing and debt issues • Dispute coverage denials and eligibility determinations • Get the most from their coverage (obtain prior authorizations, access specialists, and get out-of-network services when needed) • Access affordable health care and hospital services and prescription financial assistance programs • Understand how small business owners can offer health insurance and get health insurance tax credits • Navigate the health insurance tax credits reconciliation process CHA has completed nearly 200,000 cases for consumers across the state. We help New Yorkers: Since 2010,
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  www.communityhealthadvocates.org Winter is a29-year-old Brooklyn resident who works in sales and marketing. He was referred to CHA by a friend because he was having trouble getting his health insurance plan to cover needed health services. His CHA advocate helped him understand his benefits, navigate his coverage, and connect to the providers he needs. “It really helped to have a CHA advocate available to be on the call when I spoke to the health insurance company. My CHA advocate was able to guide the conversation and knew the right questions to ask. [On my own] I wasn’t really getting anywhere.” Thanks to CHA, Winter got the health care he needed. Winter L. Kings County
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  Community Health Advocates “Itis important for CHA to provide linguistically and culturally appropriate services. My clients are more comfortable receiving services in their language. I feel more effective as their advocate.” Meeting consumers where they are Mariyam H. CHA Advocate Community Service Society of New York
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  www.communityhealthadvocates.org Community Health Advocatesis a statewide network of organizations helping individuals, families, and small businesses use their health insurance and access the health care they need. We offer services in multiple languages through trusted local partners. The CHA network currently consists of 25 partner organizations, including three specialists (Empire Justice Center, Legal Aid Society, and Medicare Rights Center) that provide training and technical assistance. Our partners include immigrant-serving groups, social service organizations, chambers of commerce, and small business development groups. CHA’s broad-based network of groups means it can address the health care issues in New York’s diverse communities. CHA has provided services in 11 different languages and served consumers in all 62 counties in New York State. Since 2010, We’re in rural and urban communities. We serve consumers in their language. Our services are free and independent.
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  Community Health Advocates Jocelynarrived at the hospital to get emergency care for her four-year-old son, Jeremy, and was told that his health insurance was inactive. Jeremy urgently needed to see a doctor and get oxygen, so Jocelyn had no choice but to pay for it out of pocket. He received the care he needed. Worried about the bills that would arrive and Jeremy’s coverage status, Jocelyn contacted the CHA advocate at Southern Adirondack Independent Living Center. The CHA advocate found that Jeremy’s Child Health Plus plan was discontinued incorrectly. She helped reinstate his coverage to cover the cost of his care. Thanks to CHA, Jocelyn was able to get her son’s coverage reinstated. “Without CHA, I would have given up or waited too long to do something because I was so overwhelmed by the process. Hearing that there was hope and being able to talk it through with someone was probably the most valuable thing.” Jocelyn B. Mother of Jeremy Washington County CHA has helped 9,147 individuals with financial assistance programs. Since 2010,
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  www.communityhealthadvocates.org Jean* works fora small business that belongs to the North Country Greater Watertown Chamber of Commerce, a CHA network agency. The Chamber helps small employers and their employees with health insurance and health care access problems. When she started getting bills after a one-week hospitalization, Jean turned to her local CHA advocate at the Chamber for help. The advocate explained that she might qualify for discounts on her bills under the hospital financial assistance law, helped her complete an application, and got her bills significantly reduced. In cases like this, CHA offers small businesses and their employees the kind of health insurance information and assistance that Human Resources Departments provide for large businesses. Mateo is an uninsured, full-time college student living in Queens. In April 2014, Mateo needed medical care and wound up with an unaffordable bill. He contacted the CHA advocate at Make the Road New York after he received collection notices for unpaid medical bills. The CHA advocate helped Mateo find and complete the hospital financial assistance application. With CHA’s help, his bill was reduced to an amount that he could pay. Thanks to CHA, Jean and Mateo reduced their medical bills. “I met with my CHA advocate about my hospital bill. I received a 95% discount a week later!” – Jean, Jefferson County *Client’s name has been changed to protect information. “As a full-time college student, working part-time, I could not jeopardize my financial future. CHA informed me of my rights and helped me through the process of reducing my huge hospital bill. I am glad that there was someone in my community who could help.” � Mateo, Queens County
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  Community Health Advocates Oswego Madison Jefferson Broome Ch Cortland Allegany Cattaraugus Cayuga Erie Chautauqua Schuyler Chemung Tompkins Tioga Steuben Ontario Seneca Wyoming Livingston Niagara Monroe Genesee Orleans Onondaga Yates Wayne 6,22 7, “Inow have a better idea of how Medicare and Medicaid work together.” “The CHA advocate took the time to sort through my health insurance issues. I am very grateful for her assistance.” — James S. — Christine C. Monroe County Broome County 295 969 872 123 393 325 336 686 118 115 288 333 971 6,745 622 2,109 1,781 8,571 1,577 1,175 4,871 “At the end of the day I had ans possibly “The CHA Helpline advocate went abo beyond. She made it easy f “CHA helped me know where to go to save a significant amount of money on my prescriptions. I had no idea such programs existed until I called.” — Arth — Kate B. Bro Madison County Community Health Advocates 47 66 Cases by County 2010-2014 Total Number of Cases: 179,342 6,22
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  www.communityhealthadvocates.org Franklin Clinton Essex Hamilton Herkimer Warren Saratoga Washington Fulton Montgomery Albany Schoharie Rensselaer Schenectady Greene Columbia Dutchess Otsego Delaware St. Lawrence Putnam Westchester Nassau NewYork Kings Bronx Queens Richmond Orange Sullivan Ulster Oneida Lewis henango Rockland Suffolk 1,978 1,542 5,270 6,664 9,488 3,400 12,810 23,725 9,181 2,361 19,142 9,890 58 93 28 58 881 605 779 861 638 366 760 405107 201 716 451 1,208 3,316 2,820 25 3,627 1,242 2,618 750 ,762 540 572 1,008 “Thank you CHA for helping me get reimbursed from my insurance company.” “I was overwhelmed with the hospital bills and did not know how to take care of them. I am thankful that I got help from CHA and can worry a little less.” — Laurajean C. — Adam C. St. Lawrence County Schenechtady County swers. This help saved my life.” “The CHA advocate explained to me how my health insurance works.” ove and for me.” “I could not have done this without CHA’s help. They fixed the billing coding with the hospital. It was such a relief.” “Thank you CHA for all the work you’ve done on our behalf.” — Victor H. — Adahelia C. hurine W. — Andrew G. — Anonymous New York County Queens County onx County Nassau County Dutchess County 25
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  Community Health Advocates Webuild capacity in local communities CHA trains community-based organizations to respond to the health access needs of consumers in their communities. “The communities CHA assists through BronxWorks are most commonly limited English speakers. It is refreshing to see the look of comprehension on their faces when all of their health insurance paperwork and documents are explained to them in terms they can understand.” � Tina Utley Edwards, Chenango Health Network “Our CHA advocates address barriers to health care and improve access for medically underserved rural residents. CHA helps people understand and use their health insurance and links people to necessary health care and supportive community services in a timely manner.” � Donna Hynes, North Country Prenatal/Perinatal Council, Inc. “CHA provides a neutral, confidential source of information and advice around health care issues and choices, an arena in which there is so much confusion and misunderstanding of systems operation. There is no other similar service for this group of consumers in the North Country outside of CHA.” � Yinia Ramirez, BronxWorks � Greg Otten, Center for Independence of the Disabled, New York “The CHA network has allowed us to expand our reach in the community and take advantage of continuing education on changes in health care so that we can supply accurate and timely information to consumers.”
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  www.communityhealthadvocates.org “Make the RoadNew York’s CHA community presentations provide essential health access information to community members in Spanish. They are interactive and educate the community about how to access services, navigate the health system, and advocate for themselves.” � Becca Telzak, Make the Road New York CHA has held 3,509 trainings and community presentations and educated 79,605 New Yorkers about health coverage and access to care in our complex medical system. Since 2010,
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  Community Health Advocates TheCHA Helpline is ready to respond to consumers’ questions about using health insurance, disputing decisions and medical bills and helping the uninsured access affordable care. It is a live-answer, toll-free helpline staffed by trained volunteers that is open Monday thru Friday, 9 a.m. to 4 p.m. A pregnant woman wants to understand her insurance. What costs will be applied to her deductible? Will she have copays? What is her out-of-pocket maximum? What services, like ultrasounds, are considered preventive, and will be covered without any cost sharing by her plan? A woman is scheduled for surgery and wants to use an out-of-network surgeon. She wants to know: What will her health plan pay for this provider? What costs will count toward her deductible? A 12-year-old boy is quadriplegic and has cerebral palsy. His doctor has prescribed the use of an electric wheelchair, but his health plan is denying this request and wants him to use a standard, non-electric wheelchair. His father wants to know: How can he appeal this decision? How much time does he have to appeal and how long will the process take? A day in the life of the helpline Live help when you need it most CHA has responded to 25,929 calls on the CHA helpline. Since 2010, “I leave every day feeling good that I am making a real difference.” Barbara Kane CHA Helpline Volunteer Community Service Society of New York
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  Thanks to CHA,Tracey understood how to offer health insurance to her employees, while keeping her business in good financial health. Tracey contacted a CHA advocate at S2AY Rural Health Network to learn about her health insurance options as a small business owner. The CHA advocate explained the new Small Business Marketplace and how she could qualify for small business tax credits. Because of the help that she received, Tracey was able to provide her employees with coverage. CHA has helped small businesses and their employers with 19,990 cases. Since 2010, “I am relieved to know that there is a free program in my community that can help me and my employees use and understand our health insurance.” Tracey W. Owner Tri County Excavating Ontario County
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  Community Health Advocates Thanksto CHA, Roseann insurance paid for her durable medical equipment. Roseann has chronic obstructive pulmonary disease (COPD) and needed oxygen at home for the first time. Recently insured under a new plan, she was told that she would have to pay a co-pay of $500 a month for the oxygen. Roseann could not afford this on her limited income so she reached out to the CHA advocate at Chenango Health Network. After talking to Roseann’s plan, the CHA advocate was able to help Roseann get the prior authorization she needed for this durable medical equipment so it would be paid for by her insurance. “Nothing short of a god-send. With nowhere to turn and not much hope, I had just about given up until CHA helped me!” Roseann M. Chenango County
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  www.communityhealthadvocates.org Bringing the consumerexperience to health care policy Through first hand experiences, consumer stories, and data collection, Community Health Advocates informs stakeholders of trends and systemic issues that create barriers to health care and health coverage. CHA is pleased to continue to serve as a reliable resource for policy makers. While recovering from a catastrophic illness that nearly took her life, Joclyn found herself in a medical billing nightmare. Although treated at an “in-network” hospital, to her surprise, the surgeons who operated on her were “out-of-network,” and billed her upwards of $70,000. CHA intervened and saved her financial life. Working closely with the NYS Department of Financial Services and other stakeholders, CHA brought to life stories of surprise medical bills from out-of-network providers. In 2014, the New York State legislature enacted the best surprise billing and out-of-network law in the country. “Now that New Yorkers are protected by law from such billing practices, I take great joy in knowing that sharing my story with CHA and the media helped shape this public policy and will prevent other people from experiencing with this same kind of billing nightmare.” Joclyn New York County
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  Community Health Advocates Lookingto the future Thanks to New York State’s commitment to CHA, our state now has the infrastructure, programmatic experience, and knowledge to assist the more than 2 million New Yorkers insured through the NY State of Health and the millions of others who have job-based or public coverage. CHA stands ready to help individuals, families, and small businesses to effectively understand and use their health coverage and help those without coverage at all access the care they need. CHA is committed to making sure that in New York State coverage translates into access to timely, affordable and appropriate care. This report was prepared by Steffie Kinglake, MPH and Nora Chaves, M. Phil at the Community Service Society of New York (CSS). A special thanks to the CSS Marketing and Communications Department and Jessie Kavanagh, CSS intern, who dedicated time to story collection. Report design by Jeff Jones. The authors are grateful to the New Yorkers who shared their stories and the CHA advocates who continue to bring positive change to individuals and communities across the state.
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  www.communityhealthadvocates.org Name Phone CountiesSERVED ACR Health 1-800-475-2430 315-475-2430 Cayuga, Herkimer, Jefferson, Lewis, Madison, Oneida, Oswego, St. Lawrence,Onondaga bronxworks 718-588-3836 Bronx Center for THE Independence of the Disabled New York 646-442-4145 New York State Chenango Health Network 607-337-4128 Chenango, Cortland, Madison, Otsego, Delaware, Broome Community Service Society of new york 1-888-614-5400 New York State Emerald Isle Immigration Center 718-478-5502, ext. 103 Bronx, Kings, Nassau, New York, Orange, Putnam, Queens, Richmond, Rockland, Suffolk, Westchester empire justice center 1-800-724-0490, ext. 5822 Upstate New York Greater Watertown North Country Chamber of Commerce 315-788-4400 Jefferson, Lewis, Oswego, St. Lawrence Health and Welfare Council of Long Island 516-505-4426 Nassau, Suffolk Human Services Coalition of Tompkins County 1-877-211-8667 Tompkins Independent living center of the hudson valley 518-274-0701 Rensselaer, Greene, Columbia, Albany, Schenectady legal Aid Society 212-577-3575 Bronx, Kings, New York, Richmond, Queens Legal Assistance of Western New York 585-325-2520 Allegany, Cattaraugus, Chautauqua, Chemung, Livingston, Monroe, Ontario, Schuyler, Seneca, Steuben, Tioga, Tompkins, Wayne, and Yates Make the Road New York 718-565-8500, ext. 4460 718-727-1222, ext. 3442 Kings, Queens, Suffolk Richmond Maternal-infant services of orange, sullivan, and ulster counties 1-800-453-4666 Dutchess, Orange, Ulster, Sullivan, Putnam Medicare Rights Center 1-800-333-4114 New York State Mothers and babies perinatal network of scny 607-772-0517 Broome, Chemung, Chenango, Cortland, Delaware, Otsego, Tioga Nassau-suffolk Hospital Council 631-435-3000 Nassau, Suffolk Neighborhood Legal Services 716-847-0650 716-284-8831 Erie Niagara North country prenatal/perinatal council, INC. 1-800-279-8679 315-788-8533, ext. 223 Jefferson, Lewis, St. Lawrence s2ay rural health network 607-962-8459 Allegany, Chemung, Ontario, Livingston, Schuyler, Seneca, Steuben, Wayne, Yates Structured Employment Economic Development Corporation 1-866-365-0916 Bronx, Kings, New York, Queens South Asian Council for Social Services 718-321-7929 Bronx, Kings, Nassau, New York, Richmond, Suffolk, Queens Southern Adirondack Independent Living Center 518-792-3537 Clinton, Essex, Franklin, Fulton, Hamilton, Montgomery, Saratoga,Warren,Was- hington United Jewish Organizations of Williamsburg 718-643-9700 Kings CHA Network 2014
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  Community Health Advocates Tolearn more or to access FREE services from Community Health Advocates: Call: 1-888-614-5400 Our live, toll-free helpline is available Monday through Friday, 9 a.m. through 4 p.m. Email: [email protected] Visit: www.communityhealthadvocates.org CHA is a program of the Community Service Society of New York 105 East 22nd Street, New York, NY 10010