Juliette Forstenzer Espinosa & Joanna DonbeckAlumnae class of '08
In 1999, Juliette Forstenzer Espinosa (’08) was diagnosed with cancer. Soon after she started her medical treatments, she found her attention being diverted from healing the cancer to navigating the hurdles of her insurance coverage.
“It was draining,” said Espinosa. “My focus should have been on my health. Instead, I was negotiating and sometimes even begging with the insurance industry to access my coverage.” To empower people confronting the same bureaucratic nightmare, she established the Health Care Rights Initiative (HCRI).
Espinosa found that her personal experience echoed that of close friends. “Many people, including me, have private insurance, but that doesn’t mean that they have good coverage or don’t face obstacles accessing their coverage,” she noted. “In fact, the new health care reform law does not address the majority of systemic abuses endured by patients with health insurance.” Espinosa said that there are more than 160 million patients with private health insurance who can easily find themselves in an insurance predicament. Most people are unaware of how limited their legal rights are, and when trouble strikes, they are equally alarmed at how difficult it is to find an advocate to help them fight back effectively.
In addition to her J.D. from CUNY Law, Espinosa earned an LL.M. degree in the Employee Retirement Income Security Act (ERISA) from Georgetown University Law Center in Washington, D.C. ERISA, which sets minimum standards for private sector employee health insurance plans, along with other workplace benefits, limits legal remedies for patients whose insurance claims have been illegally denied.
“What I discovered is that all the basic concepts around contract law and tort law don’t apply to most health insurance companies,” said Espinosa. “The preemption provisions in ERISA shield companies from liability; no juries are permitted in ERISA claims; attorney fees are not guaranteed in litigation; and no punitive damages are permitted,” she said. “This lack of legal remedies leaves patients without recourse. I wanted to create a new set of tools for the public. HCRI works to increase a patient’s access to health care and to deal with insurance companies at a time when patients and their families are understandably overwhelmed by other concerns.”
HCRI was started with the support of the Incubator for Justice Project, part of CUNY Law’s Community Legal Resource Network (CLRN). “The Incubator for Justice was instrumental in helping me to establish HCRI. We have learned from past incubator participants about creating a nonprofit, and we have a community of new lawyers to confer with on procedural questions. Plus, we get affordable office space and have Fred Rooney, director of CLRN, and CLRN members to mentor us as we grow,” said Espinosa.
HCRI teaches patients how to understand their health insurance coverage, contests wrongly denied insurance claims, identifies and corrects medical billing errors, and works with families to organize and track medical and insurance paperwork, among other activities.
Espinosa hired her CUNY Law classmate Joanna Donbeck (’08) as HCRI’s director of advocacy programs and staff attorney. “What I have learned in assisting each of our clients is that empowering patients, through education and outreach, before a health crisis occurs is absolutely essential to increasing and improving patient access to health care. There are concrete things patients can do before seeking medical care to protect themselves. Once claims have been denied and medical bills have been issued, the barriers to accessing care become much stronger, and an advocate is an absolute necessity,” said Donbeck.
“Patient education and advocacy are urgently needed,” observed Espinosa. “It’s time that health care providers and the insurance industry stop putting profits over people. HCRI is working on behalf of that change.” Visit www.yourhealthcarerights.org for more information.
