Guest:  Kristen Yansick

Topic:  Independent Consumer Advocacy Network (ICAN) Appeals

Host:  Welcome to Independent Perspective, a public affairs presentation of Western New York Independent Living (WNYIL). Our guest today is Kristen Yansick, Independent Consumer Advocacy Network (ICAN) Outreach and Advocacy Coordinator at WNYIL and your host is yours truly Ernie Churchwell. Welcome to the program, Kristen.

Guest:  Thank you for having me.

Host:  It's our pleasure. I'm willing to bet that a lot of people listening are not familiar with the Independent Consumer Advocacy Network, or as we like to call it, ICAN, but I'm sure that you can enlighten them. First of all, who is intended to serve, and in what ways do you do so?

Guest:  So, the ICAN program is an ombudsman program through New York State's (NYS) Department of Health (DOH), so technically I'm a third party contracted employee here. I report directly to the DOH. So as an ombudsman, I assist people in filing complaints and going through the appeals process with their managed long term care insurance, whether it be a health and recovery plan, managed Medicaid plan, dual eligible, so Medicare and Medicaid, or if they have managed Long Term Care Insurance. There's a variety of different services so if someone were to ask for an increase in a service and be denied. If someone were to go through any type of appeals process for a service that they requested that they're not receiving, they need to learn how to receive it. I do everything from assisting people with referral to legal representation for fair hearings, through the appeals process all the way down to just providing information of how the insurance company works and how the healthcare system in general works.

Host:  By the way, in case some people don't do rehab speak very well, when you say ombudsman that's essentially a fancy word for individual advocate that goes to bat for person, correct?

Guest:  Yes.

Host:  Great. It sounds as though you play a pivotal role in a number of things, what are some instances where your intervention is particularly called for?

Guest:  So right now, throughout NYS, this has been noticed by the ICAN network since we also have providers who are also in downstate New York, New York City. There has been a reduction of Consumer Directed Personal Aid Services (CDPAS) across the board from every insurance plan that offers managed Long Term Care Plan, or a managed Medicaid plan so right now, the bulk of the individuals that I help are having issues where they're not receiving the amount of hours they feel like they need to be independent in their home, or they have an assessment done that states that it's not medically necessary for them to have the amount of hours they currently have and they're being reduced. So, I go to bat with that person and I am an intermediary between them and their insurance company in assisting them for obtaining reasons of why they need those care hours.

Host:  As many people have probably heard from the news, NYS has been sweating, something like $4 billion shortfall in social programs including Medicaid and similar things and as a result, a CDPAS has been a subject for considerable negotiation. Are you finding that makes it difficult, since you answer directly to NYS?

Guest:  It does, yes. NYS DOH is on our sentinel calls, so we do have calls once a month with other providers in the area. Also, the DOH where we tell them the trends that we see right now, they have informed us that the insurance companies, all of them across the board are currently going through the review process. So, a big part of my job is helping people file complaints against the insurance company if they weren't treated properly or according to procedure or policy. So those currently are being under review and the more complaints that are submitted, obviously, the quicker the review process goes in a particular area that has the most complaints. So right now, they are taking a bit of their time with the DOH, looking through and scouring through and seeing which cases are familiar and how many complaints have been filed for this same reason.

Host:  I'm sure people will have questions; how can they reach you to ask?

Guest:  My phone number here is 716-836-0822 at extension 251. Or I have a coworker Emmet and his extension is 127, so he can also be reached as well.

Host:  We very much appreciate all the work you do and you're coming on the program to tell us about it. Thank you so much.

Guest:  Thank you.

Host:  You've been listening to Independent Perspective, a Public Affairs presentation of WNYIL. Our guest today was Kristen Yansick, ICAN Outreach and Advocacy Coordinator at WNYIL, and your host is yours truly, Ernie Churchwell.