EmblemHealth Won’t Talk To Me About My Husband’s Coverage Because We’re Both Men

John has filed a Division of Human Rights complaint against NY-based Emblem.

John and his husband, who live in New York where same sex marriage is legal, are both covered by John’s employer-sponsored insurance from EmblemHealth. But John says that every time he tries to contact Emblem about anything regarding his husband’s coverage — no matter how trivial — the company refuses to acknowledge the two men are married.

According to John, whenever he contacts Emblem and brings up the topic of his husband’s coverage, he is told that nothing can be discussed unless John first obtains a signed, notarized affidavit giving him power of attorney over his husband’s affairs.

“This seems just crazy to me,” he tells Consumerist. “So, I asked my co-worker, who has the same insurance as I do and she says she has absolutely no trouble whatsoever calling up and discussing medical insurance issues for her husband or her child.”

The co-worker tells John that she contacts Emblem frequently regarding her family members’ coverage and she has never once been asked for any kind of authorization, nor has the company in any way challenged her right to coordinate insurance matters for her entire family.

“Why is my family different then?” asks John, who says that when he contacted Emblem to ask why the co-pay on his husband’s eye drops increased from $20 to $50, he was told this information was private. He explains the reason that he is the one making these calls to Emblem is that his husband is a Spanish-speaker who comes from a country where things like HMOs and deductibles and co-pays are unheard of.

John recently filed a complaint with the New York State Division of Human Rights, which conducted an investigation of the matter. His coworker who has no problems with getting Emblem to discuss her family’s coverage provided a sworn statement to the investigator.

Emblem’s response to the DHR investigation was to claim that it “does not have an employee-employer relationship with [John] and so [Emblem] believes that this complaint falls outside the scope of the types of complaints handled by the Division of Human Rights.” The company also says that it explained to John that Spanish-speaking customer service reps could be made available.

The DHR investigator concluded that the Division does indeed have jurisdiction in this matter and that probable cause exists that Emblem’s actions are violating the state’s Human Rights Law.

A public hearing on the matter is still to be scheduled.

“Amazingly, EmblemHealth still stubbornly insists that it will not deal with me regarding my husband’s insurance issues,” says John. “Do they need to be dragged kicking and screaming into reality, or are they willing to fight for the right to pretend it’s still 1950?”

One insurance expert tells Consumerist that some insurers do take a very hard line on privacy and won’t speak to spouses about their loved ones’ coverage. However, adds the expert, whatever privacy policies the company has should be applied equally to all customers.

UPDATE: After the story was posted, Emblem finally responded to Consumerist’s request for comment.

The company says it is merely following federal Health Insurance Portability and Accountability Act privacy guidelines:

“HIPAA regulations are absolutely clear on this point. No health care professional, no insurer, no one involved in the process may discuss a customer’s or patient’s care without express written consent of the customer or patient. EmblemHealth customer service representatives understand and comply with this important regulation for all of our members.”

When asked about the sworn statement of John’s co-worker that she was able to discuss her husband’s coverage without having to show a power of attorney affidavit, an Emblem rep stated that the company could not “validate” that such calls ever occurred.