Individuals and Small Businesses

New York’s managed care health plans provide comprehensive health care services to nearly eleven million adults, children and seniors. These New Yorkers include those enrolled through their employers and individuals who shop for coverage through the state’s official Marketplace or directly from plans. The following member* stories offer real examples about how plans support the health care needs of their members.

* Some names have been changed to protect member privacy

Julie

Julie M. woke up in the middle of the night and found it difficult to breathe. She couldn’t take in air, and for the otherwise healthy 58-year-old, nothing like this had ever happened before. She was advised to go an emergency department, or a designated cardiac urgent care center like, Enhanced Cardiac Access at 1785 in Clifton Park.

A small wave of comfort washed over Julie to hear the numbers 1785. Julie, who worked in the field of mental and behavioral health care, was called upon in 2019 to serve on her health plan’s Member Advisory Committee to help design of the 1785 building—a joint venture between CDPHP and several local independent specialty medical practices.

Upon arriving, Julie says she was greeted by compassionate and caring staff and had no wait time before being seen. Julie is grateful for the quick, compassionate care she received. “I was able to get results right away and hear the comforting news that it wasn’t serious.”

Michael

“Can you feel lucky that you had a heart attack? I don’t know,” wondered Michael O. It may seem strange to say, but for the 57-year-old artist, college professor, the life-changing experience has not only amplified his artistic creativity, but also taught him more than a little about the importance of self-care and healthy habits.

Within days of his heart attack, clinical staff from CDPHP’s Hospital to Home team connected Michael with Movn, a unique virtual cardiac rehabilitation program developed by a California-based company and first introduced in the Capital Region by CDPHP in early 2021. While the number of patients completing cardiac rehab in a traditional setting has historically been low, Movn has impressive results, with over 80 percent of participants completing the program, 85 percent doing better controlling their blood pressure, and 95 percent adhering to their medications. CDPHP’s medical director says Movn is “a game-changer” when it comes to improving access to cardiac care for members.

For Michael, the convenience of the virtual program is most of what has kept him engaged in his rehab and helped him prioritize self-care overall. Now, a year after his heart attack, Michael feels stronger, has more energy, is eating better, and getting more sleep. And his creativity has grown as well. “A lot of my work has been about preserving objects, material culture, things that I find in archives to use in my art,” he explains. “So now, I guess, I’m in this new place of wanting to preserve myself.”

Simon

Simon W.* is member of United Healthcare. During a vacation in Mexico, Simon’s wife fell very ill and had to be transported to Florida. As her condition worsened, Simon worked with the hospital care coordinator to get his wife back to New York, and was told that transportation by medevac was approved.

He later found out that the care coordinator had made a mistake and the authorization was not approved, forcing him to cancel the medevac reservation. Wanting to get his wife back home so she could receive the care she needed at their local hospital, Simon turned to United Healthcare’s call center and was connected with a Health Advocate. The Health Advocate took immediate action to find a resolution, demonstrating empathy and care throughout the process. Keeping Simon informed every step of the way, the Health Advocate worked with the case manager to expedite the case and get the transportation approved, allowing him to safely get his wife home to receive much needed care.