Network changes, delays vex clients
By Kay Lazar, Globe Staff | November 5, 2009
The Patrick administration has trumpeted its salvaging of health insurance for 28,000 legal immigrants, but the company hired to cover this group has been late assigning doctors and sending enrollment information to many patients, health and immigrant advocates say.
Even some patients who received the necessary information are facing significant hurdles connecting with the doctors CeltiCare Health Plan of Massachusetts assembled in its new network, which sharply limits the community health centers and hospitals available to patients.
“Often the new providers are a long way from where they live, and this is a problem for immigrants who have to use public transportation,’’ said Franklin Soults, a spokesman for the Massachusetts Immigrant and Refugee Advocacy Coalition, the state’s largest immigrant group.
“The new places,’’ he added, “don’t have the translator services that their former providers do.’’
The new health coverage was scheduled to start Oct. 1 for about 12,000 of the immigrants in the Boston area, and on Nov. 1 for another 10,000 on the North and South shores. Coverage for the rest begins Dec. 1.
CeltiCare, which is being paid $36.5 million over nine months, defended its performance yesterday, saying that delays in mailing enrollment information and doctor assignments to patients were the state’s fault, because it was tardy providing a list of immigrants’ names and addresses.
“We have 15 days, once we receive the list from the state, to send patients their packets,’’ said Brian Delaney, a CeltiCare spokesman.
Richard Powers, a state spokesman, said that on Oct. 27 CeltiCare was provided with a list of patients whose coverage began Nov. 1. “We were not late,’’ he said.
Packets were being mailed yesterday, Delaney said, for patients whose coverage was supposed to start Nov. 1. He said packages went out during the first week of October for those whose coverage was scheduled to start Oct. 1.
“We aren’t naïve, that there is not going to be a misaddressed or an individual problem here or there, but we are dealing with that,’’ Delaney said, adding that company call centers have received no complaints.
“Since Oct, 1,’’ Delaney said, “better than 90 percent of [customer calls] have been answered by a live person within 30 seconds.’’
Hotline counselors at Health Care for All, a large Boston-based consumer group, are hearing complaints.
“Our HelpLine counselors are hearing about a number of glitches, from delayed welcome packets to difficulties communicating with CeltiCare’s call line,’’ said Lindsey Tucker, one of the group’s policy managers.
In Belmont, Brazilian dancer Rosangela Santiago said she tried, in vain, for an hour earlier this week to reach CeltiCare’s customer service department. Santiago has been sidelined by a foot injury that requires cortisone shots and physical therapy for rehabilitation. Her CeltiCare coverage is not scheduled to begin until Dec. 1, but she received a letter Oct. 1 from her caregivers at Cambridge Health Alliance saying they would be unable to provide care after Oct. 31, because CeltiCare did not contract with them. Now the 35-year-old does not know where to turn.
“I get a recording that says . . . ‘Your call is important to us,’ and I wait on hold for over an hour,’’ she said of CelticCare.
When Santiago looked on the company’s website to find a doctor, she said it showed none available in her ZIP code.
Legal immigrants’ coverage under the Commonwealth Care plan, the centerpiece of the state’s landmark 2006 health care overhaul, expired Aug. 31, after lawmakers eliminated $130 million for their care to help balance the state’s budget.
Ultimately, legislators restored $40 million, and CeltiCare stepped in to offer a reduced-rate package that will keep core medical services, such as routine doctor visits and hospital treatment, but excludes more comprehensive care. Some patients will also have to pay significantly higher copayments for medications and other treatments.
CeltiCare’s list of health care providers is largely composed of lower-cost community health centers and a small number of hospitals. The network excludes many medical institutions that specialize in treating immigrants, and that is leading to disruptions in their care, said executives at several Boston-area hospitals that were not offered CeltiCare contracts.
The state’s contract with CeltiCare requires the company to provide at least one hospital in each county and provide each patient with a choice of at least two primary care physicians who are accepting new patients, are “appropriate and culturally sensitive,’’ and are located within a 15-mile radius or 30 minutes travel time.
Last week, a state agency blocked the company from offering health coverage to the public until April, saying CeltiCare does not have an adequate number of medical providers in its network for that product. But it did not make any determination about the adequacy of the company’s network for immigrants or for other lower-income patients who also receive state-subsidized health insurance from CeltiCare.
Many of the CeltiCare patients live in Lawrence, which has a large Spanish-speaking population, but Lawrence General Hospital and its affiliated community health center did not get a contract with the company, forcing more than 1,400 patients to make new care arrangements.
Among them is Amparo Villa, a 51-year-old Dominican immigrant who through a translator said she takes 16 medications for chronic illnesses including diabetes, hypertension, asthma, and arthritis. She will now have to take a taxi to Holy Family Hospital in Methuen every time she needs to see a doctor, a $14 round trip.
“It’s expensive for me to go to Methuen,’’ said Villa, who takes home just $220 a week from her custodian’s job.
Kay Lazar can be reached at klazar@globe.com.
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