"New Yorkers Unaware: Insurance Policy Leaves Residents Potentially Overwhelmed with Debt"
In a move that has sparked state investigations and public scrutiny, Leading Edge Administrators, a health insurance third-party administrator with a questionable past, has recently secured a substantial taxpayer-funded contract to provide insurance coverage to home health workers in New York.
From 2012 to 2020, Leading Edge operated a health insurance plan, during which it collected approximately $24 million intended to fund home care. However, reports suggest that the company gave out at least $22 million less than expected or owed, raising concerns about underpayment.
One of the most troubling aspects of Leading Edge's business practices is its documented pattern of delaying or denying payments to doctors and caregivers, resulting in unpaid bills that are redirected to patients. This has caused significant financial and emotional distress for both healthcare providers and the patients relying on coverage through Leading Edge’s plans.
Robyn Hodgson, a journalist and writing teacher, is one such patient. Hodgson, who has a rare genetic condition that requires frequent surgeries to remove tumors, has had cancer twice and experiences migraines, chronic pain, and hand tremors. Due to Leading Edge's refusal to pay for her treatments and surgeries, Hodgson has accumulated more than $20,000 in unpaid bills.
In a concerning turn of events, on May 1, Leading Edge became the health insurance provider for hundreds of thousands of New York's home health care aides. Hodgson, like many others, was shifted to Leading Edge's insurance plan. The $17,106 that Leading Edge charged Hodgson for a tumor removal surgery in October was eventually changed to $0.
However, for Hodgson and others, the switch to Leading Edge's plan has brought more problems than solutions. If full-time home health aides decide they don't want to use the Leading Edge insurance, they may be left with Affordable Care Act plans that generally cost at least $7,200 per year. This is essentially impossible for a low-paid health care worker to afford.
Moreover, many home health aides, like Nicole Demme who works as a home health aide caring for her disabled son outside of Buffalo, have cut back their hours to avoid being a full-time worker and risk getting kicked off the Essential Plan, a cheap and comprehensive public insurance program.
The former employees who worked in operations and customer service at Leading Edge have revealed that if full-time home health aides decide they don't want to use the Leading Edge insurance, they may be out of luck, since the company's plan for them could cause them to lose the insurance they now have.
Leading Edge's strategy is to offer doctors a certain price, pay only a part of it, and put the remainder on the patient's bill. This practice has not only caused financial harm to patients but has also led to caregivers losing their jobs or patients losing essential care.
The controversies surrounding Leading Edge extend beyond its business practices. In 1997, the company's founder, Jerry Weissman, was found guilty of health insurance-related crimes and sentenced to 18 months in prison. More recently, Empire Blue Cross Blue Shield was sued for pervasive and deliberate underpayment related to its work with Leading Edge in 2021.
As investigations continue, it is crucial to hold companies like Leading Edge accountable for their actions and ensure that vulnerable populations like home health care workers and their patients receive the care they deserve.
- The investigations into Leading Edge Administrators, a health insurance third-party administrator, have intensified due to their recent substantial contract to provide insurance coverage to home health workers in New York, which is funded by taxpayers.
- From 2012 to 2020, Leading Edge managed a health insurance plan, during which they supposedly collected around $24 million for home care but gave out less than expected or owed, roughly $22 million, causing concerns about underpayment.
- One of the alarming aspects of Leading Edge's business practices is their documented pattern of delaying or denying payments to doctors and caregivers, leading to unpaid bills for patients, causing significant financial and emotional distress.
- Robyn Hodgson, a journalist and writing teacher who suffers from chronic medical conditions, has faced hardship due to Leading Edge's refusal to pay for her treatments and surgeries, resulting in over $20,000 in unpaid bills.
- Despite Leading Edge becoming the health insurance provider for hundreds of thousands of New York's home health care aides, many have faced more problems than solutions, particularly those who are low-paid and may not be able to afford alternative insurance plans under the Affordable Care Act.
- If full-time home health aides choose not to use Leading Edge's insurance, they may be left with Affordable Care Act plans that typically cost at least $7,200 per year, an amount almost impossible for them to afford.
- In an attempt to avoid being a full-time worker and getting kicked off the Essential Plan, a public insurance program, many home health aides have reduced their work hours, putting their patients' care at risk.
- Former employees of Leading Edge have disclosed that if full-time home health aides decide to opt out of Leading Edge's insurance, they may face loss of insurance coverage due to the company's plan potentially causing them to lose their existing insurance.
- Beyond its business practices, Leading Edge's controversies extend to its founder, Jerry Weissman, who was sentenced to 18 months in prison for health insurance-related crimes in 1997, and more recently, Empire Blue Cross Blue Shield's lawsuit for pervasive and deliberate underpayment related to their work with Leading Edge in 2021.
