Pensacola's indigent and homeless targeted by 'aggressive' insurance brokers'

People who are homeless or indigent are being taken advantage of by out-of-town insurance brokers, according to homeless advocates who say the brokers are all but bribing people who live on the street to sign up for policies they can’t afford and ultimately making it harder for them to get health coverage.

The issue is just one of many homeless individuals face regarding healthcare.

Chandra Smiley is CEO and executive director of Community Health Northwest Florida, one of the primary places people who are homeless and low-income can go locally for medical care. Last year alone Community Health saw almost 10,000 homeless patients at the organization’s 22 sites in Escambia and Santa Rosa counties.

Smiley said for at least the past nine months insurance brokers have traveled to the Pensacola area and “aggressively” convinced people to sign up for health insurance that ended up creating more problems than it helped.

The brokers typically then get a commission from the insurance companies for each person they sign up.

“These brokers, from best we can tell, they're coming out of Jacksonville, coming over here and literally in the middle of the night, waking people up off the park bench out front of Alfred Washburn and getting them to enroll in these advantage plans,” Smiley explained. “They give them like a $20 gift card or something similar, and so these individuals would enroll and then lo and behold, their co-pays are high.”

Leigh Oliver, a case manager with Lakeview Center’s mental health services outreach program, Homeless Evaluation Assessment Response Team (HEART), has also heard from clients who were approached to sign up for private health insurance plans, and has even seen the brokers in action.

Oliver said one insurance broker she spoke to gave her a card with an address in Georgia.

“I've actually seen them on, not street corners, but at stores where there's a higher homeless population,” said Oliver. “I would see them at maybe say, the Dollar General or something like that, where they were street hustling. That's probably not the correct political term, but that's kind of what they were doing. I've heard stories (from clients) of them offering $1 to $5 to $50 gift cards to tablets to just various, different things.

“You know when you have an individual who has nothing in their pocket, if you say I'm going to give you $5, (the individual says), ‘OK, here's everything I have,’ Oliver continued. “They're getting their Social Security number. They're getting copies of their ID. What that information is used for, I've never truly figured out. I've had individuals say that they filled out the (insurance) application like they would have a paper application, some have electronic, and some have had paper and they would have the individual complete the entirety of the application.”

Worthless insurance prevents real coverage opportunity

Not only can most not afford the co-pay, in some cases their pharmaceutical coverage is inadequate and expensive and their primary care physicians are located hundreds of miles away in another city. As a result, they don’t get the care they need, and the private coverage means they can’t qualify for the Medicare or Medicaid plans for which they normally would.

“We were trying to work with the patients on getting them converted back to straight Medicare or whatever they had before and there are challenges that come with that because we're talking about a transient population and they have to make the call (to the insurance company). So what we ended up doing was enrolling (in one of the insurance networks signing up individuals). So now we're like, ‘Well, at least we're in the network,’ and they can come to us for care and then maybe we can get them transitioned over to Medicaid afterwards, because really what's best for the patient is for them to have that straight Medicare or Medicaid.”

Homeless shelters across the area have reported kicking health insurance brokers off their campuses. Community Health operates a clinic at Waterfront Rescue Mission in Pensacola, where staff have banned brokers from their property.

“They're praying on the vulnerabilities of individuals that are being lied to about what they need and how to get it,” said Clay Romano, president and CEO of Waterfront Rescue Mission. “Then that literally keeps them from being able to actually see someone here on campus or even one of the other locations for Chandra's Community Health or even Health & Hope Clinic. It's disgusting to be quite frank with you, so we'll prosecute them to the fullest extent of the law.”

Respite Dorm program offering some relief

The issue highlights the need for more medical care for those who are homeless and indigent. One way advocates are trying to address that is through a pilot Respite Dorm program at Waterfront offered in partnership with Community Health. The program offers people a place to stay and recover after they have been discharged from the hospital. Without it, most are returned to the streets, which is not a safe or healthy place to recover.

“They need a safe, clean space to just rest up for like a week,” said Smiley. “If you and I went and had gallbladder surgery and they said stay home for a week, we've got our nice, comfortable homes that are clean that we can rest in. For folks who are homeless and they're not in a shelter or in a program, they're sleeping in campsites and out in the woods (and that is) just not the best place to recuperate. These beds are really for those who are being released from the hospital and they need to recuperate for a week or two. Depending on what their condition is and what they're being released for, it's a place where they can go and receive some care.”

There are currently 10 hospital beds in the dorm and there are plans to add six more in a room next door. Details are still being decided but medical staff and case managers will be available to provide care and offer services to help them transition out of homelessness, if they choose.

Without these beds, many people are simply being dropped off literally on the side of the road or on the doorstep of shelters like Waterfront. Romano said they’ve had two such cases recently. In one instance a man missing a leg was left in front of their campus with his prosthetic limb propped up on a nearby pillar, and another involved a woman.

“A healthcare facility two counties over put her in a cab, brought her here and the cab driver dropped her off at about 9:30, 10 o'clock at night,” Romano described. “Left her in the front yard of our campus where she stayed for the entire night until she crawled from the grass over the concrete to where she stopped, right in front of our door where I found her. We have to stop allowing this to continue to happen. It happens more often than I care to admit.”

Before becoming president of Waterfront, Romano worked at Baptist Health Care where he helped found the Faith Health Network, a network of organizations that educate and help people who are low income or uninsured access healthcare services without relying on hospital emergency rooms for everyday medical issues, which drives up costs and wait times.

“They've been clamoring for something like this for a long time because unfortunately the reality is when a homeless person becomes ill, they’ll find themselves in the ED (emergency department), which is the most expensive access point for the healthcare system. They don't have a primary care provider. The ED is their primary care and they're bottlenecking the services of people who are maybe experiencing an acute care situation.”

For that reason and others, Romano said local hospitals are interested in supporting the Respite Dorm concept, possibly through sponsorships. Romano said West Florida has agreed to be a part of the program and they’re still working out memorandums of understanding with Baptist and Sacred Heart hospitals.

About three dozen people have come through the pilot respite program so far. Romano said they hope to officially open in the near future, but they are still putting the full program together. In the meantime, they are securing more hospital beds from Baptist’s legacy campus that became available after the hospital moved to its new campus.

The plan is to eventually offer 16 beds at Waterfront’s Pensacola campus and another 10 at their site in Mobile, Alabama, where health care providers are also interested in collaborating. The need is far greater than the limited number of beds they can offer now, but advocates say it’s a place to start, especially because adequate medical insurance coverage can provide additional revenue to help those who need care.

“We take them, and we give them an option for a clean, healthy environment,” said Romano. “We're going to give them the home life care that they don't necessarily have and at the same time generate a revenue stream by doing that for the healthcare systems, so the healthcare system wins, we win and the person becomes healthier faster, and we get a chance to change their life in a in a positive way through other services.”

This article originally appeared on Pensacola News Journal: Healthcare for Pensacola homeless hampered by insurance brokers