Athena nursing home workers say medical bills still going unpaid

The symptoms of multiple sclerosis show up differently in Jamie Iszczak’s body depending on the day.

Sometimes it presents as pain, tingling or numbness in her leg. Her vision may blur. At times, an arm hurts, or she feels crushing fatigue.

But getting treatment for those ailments has become equally problematic. She hasn’t been able to get an MRI for more than two years — a scan crucial for her doctor to see whether and how her condition has progressed. Some of her physicians, including her primary care doctor, won’t allow her to make an appointment. And the facility that draws her blood recently threatened to cut off services due to unpaid bills.

Iszczak, 45, said the problems started after Athena Health Care Systems — one of the largest nursing home chains in the state and the company where she has worked as a certified nursing aide for 22 years — stopped paying employee health care claims on its self-insured plan.

She estimates she has received medical bills totaling more than $85,000, and collection agencies have been calling, even though Athena continues to take $35 from her paycheck each week for insurance coverage.

These days, Iszczak said, she is living with more pain.

“I’ve always been the type of person who’s pushed through, but you can only push through so much,” said Iszczak, who works at the Litchfield Woods nursing home in Torrington. “I’ve been waiting over two years to have an MRI done, and they have not approved it. Anytime I have pain in my head or something’s off, I wonder if there’s a new lesion forming. If I have pain in my arm, maybe there’s a new spot. I constantly worry. It’s very stressful, not knowing.”

Athena CEO Lawrence Santilli has acknowledged in letters to staff that the company is behind on paying employee health claims.

In a November 2023 email, previously reported by The Connecticut Mirror, Santilli said the company was six months behind on paying claims.

“Unfortunately, the employee health plan currently has a significant funding shortfall,” Santilli wrote in the memo to staff. “Athena has not been able to promptly meet all the funding requirements of the employee health plan. … It is our intention to fully fund all outstanding claims in the upcoming new year.”

But several workers from Connecticut and Massachuetts who spoke to the CT Mirror say that so far this year, the problem has not been resolved.

Some said they cannot schedule routine appointments with primary care doctors, gynecologists or specialists because of unpaid health claims. Others can’t get approval for X-rays or mammograms. Some hesitate to seek treatment or arrange procedures.

Employees who spoke to the CT Mirror say Athena has continued to take money from their paychecks for insurance — some as much as $140 per pay period. They question where the money has gone. And workers have filed complaints with several state agencies, from the Attorney General’s Office to the Department of Insurance.

Additional memos from Santilli to staff obtained by the CT Mirror show that Athena’s issues with paying health care claims date back to 2021, farther than what was previously known publicly.

On Oct. 28, 2021 , Santilli wrote: “We are aware of certain communications some employees may have received that caused understandable concern regarding medical coverage. … Payments continue to be made weekly to the health plan … we are, however, behind on those payments and doing our best to catch up.”

He blamed the COVID pandemic, saying additional federal and state money directed to nursing homes was not “sufficient to fund all our COVID costs and lost revenues.”

A little more than a year later, on Dec. 1, 2022, he sent another note : “One of the federal sources of income we have been working hard on since January of 2022 is finally materializing. … We anticipate that all outstanding claims processed through November 29, 2022 will be paid no later than January 9, 2023.”

But in November 2023, he issued the memo saying the company was six months behind on worker claims.

Several Athena workers who spoke to the CT Mirror described receiving unexpected medical bills, some for hundreds of dollars and others for tens or hundreds of thousands. Many are being hounded by collection agencies.

A spokeswoman for Athena said the company continues to communicate with staff about the health claims.

“We understand outstanding health insurance claims are a significant concern for our employees and their families, and we are actively working to address this issue,” Savannah Ragali, a spokeswoman for the company, said in an email. “Athena has not been able to promptly meet the funding requirements of the employee health plan. As a result, we are behind in paying submitted health claims.

“Due to the plan design, employee contributions fund 10% of the health insurance plan and Athena funds the remaining 90%. Though payments are still being made, the volume of claims has exceeded the ability to process them in a timely manner.”

She did not answer questions about how much in total the company owes for health care claims or how far back the unpaid claims date.

The most recent documentation shows that 2,447 employees are enrolled in Athena’s health plan, though the company last month sold five of its facilities and does not yet have updated numbers, Ragali said.

As part of the sale of the five homes to National Health Care Associates, National agreed to add $2.6 million to the health insurance fund to cover benefits for employees of those facilities.

Athena still operates 14 skilled nursing facilities in Connecticut, 16 in Massachusetts and five in Rhode Island.

State agency leaders and Attorney General William Tong are directing workers who have filed complaints with their offices to the U.S. Department of Labor. The federal DOL’s deputy regional director for public affairs said he could not comment on a pending investigation.

“The whole point of paying for health insurance is that it’s there for you when you need care. That hasn’t been the case for Athena employees, and that’s unacceptable,” Tong said. “As Athena’s self-insured plan is federally regulated, state agencies are limited in what we can do to intervene. That being said, we have been working closely with the U.S. Department of Labor and have encouraged any Athena employee experiencing health insurance challenges to file complaints with both DOL and the Athena ombudsperson.”

Ragali said the company is working with the federal DOL and state agencies.

“We are continuing to work diligently to address this critical issue and are communicating with our staff about the significant payment delays of their health care claims,” she said. “We are also collaborating with the U.S Department of Labor as well as state and local officials to address this situation.”

Complaints mount

Since January 2022, 49 complaints have been filed with the Connecticut Insurance Department against Athena for non-payment of health claims.

Records identify Athena’s insurance provider as S&S Health.

The department doesn’t have the authority to regulate self-insured health policies, which is the type of plan Athena’s employees are enrolled in. But still, the complaints have mounted.

The grievances are varied and troubling.

“I am in collections with Western CT Health Network (Nuvance) … for the unpaid claims by my employer of $234,285 for treatment of my deceased spouse,” one worker wrote in January 2023 . “He passed away on 3/5/21. I have received numerous letters from this law office that have been brought to my employers’ attention at the corporate level.

“I am fearful that at this time, my wages could be garnished and/or I am in danger of losing my home!!”

The CT Mirror received copies of the complaints through a public records request. The names and personal medical information of those who filed them were redacted.

“I carry my husband on my insurance plan and have money taken from my check weekly. This past Friday I received a collection notice,” said an employee of Athena’s Beacon Brook nursing home in Naugatuck, in an April 2023 grievance . “My husband’s co-pay was paid by him. Apparently, the payment did not happen by the insurance company. I have spoken to HR, who is reaching out to corporate. Regardless, I am beyond frustrated with the negligence that is going on. All bills should be paid.”

Another worker wrote in November 2023 that they were left with a bill for $13,823 after an operation.

“I had my gallbladder removed on 5/3/23. I received a letter beforehand that the surgery was approved,” the employee said. “I received a letter in July from the hospital stating they had not received any response from the insurance company for payment. I then received a bill from the hospital.

“I have made several calls to the insurance company and the hospital but have not gotten any resolution.”

An employee at a medical office also reached out to the insurance department in August 2022 about payment problems with S&S.

“I work for a physician’s office and some of my patients have insurance through S&S strategies. These people are awful. I have some claims over a year old now that they are not paying,” the worker wrote . “When I go online to check on payment all it says is ‘in process.’ I have talked to my patients on this plan and was told that Quest sends them to collection when the insurance payment is overdue. I’m sure other places do also. I’m not sure how this place gets away with this. The patients are paying for this insurance and the insurance doesn’t seem to pay out.”

A telephone message left with S&S Health was not returned.

State insurance officials are referring the Athena workers to the federal Department of Labor.

Thirteen complaints were filed with the Connecticut Attorney General’s Office during the same timeframe, and six were submitted to the state Office of the Health Care Advocate.

The state Department of Labor received two complaints. State labor officials said one is under investigation and the other awaiting assignment to an investigator. The department has opened an investigation into possible wage theft because the company took money from employee paychecks but did not fund the health claims.

In interviews, several Athena workers described the stress of being pursued by collection agencies and of being unable to access medical care.

Yvonne Smith has worked as a nurse at Parsons Hill Rehabilitation & Health Care Center in Worcester for 25 years.

Smith, 63, said she pays $140 per paycheck to get Athena’s “gold” health care plan for her and her husband. So when debt collectors started calling about medical bills that weren’t being paid, she was angry.

“The whole thing ticks me off. Where is our money going that’s been taken out of my check every week for all these years?” she said. “Now I have debt collectors calling me all the time because Athena is not paying the bills.”

Smith has had two medical procedures canceled because some hospitals no longer accept Athena’s health insurance. An endoscopy scheduled at UMass Memorial Medical Center in Worcester was called off earlier this year, and a treatment for her osteoporosis was canceled a few months ago when she told the doctor she had health coverage through Athena.

Smith said nearly everyone she works with is getting harassed by debt collectors.

“Our insurance is like a bad credit card. Nobody wants to take it,” Smith said. “It’s impacting everybody’s health because of the stress that people are under when they can’t even get their routine doctor appointments.”

Cindy Bennett, a certified nursing assistant at the Litchfield Woods nursing home, has been battling lung cancer.

Bennett, 61, estimated she has received medical bills totaling about $80,000 — some of them from unpaid radiation treatments — and she has heard from collection agencies. A CT scan recently revealed two spots that were concerning to her doctors, and she worries she won’t be approved for a follow-up PET scan.

“That scares me every day. I mean, you’re going through lung cancer and all of a sudden they could say, ‘No, you can’t come here,’” Bennett said. “I can’t afford a PET scan [without insurance], but I need it. That’s going to see if the cancer is still there.

“I could die from this and you aren’t paying my bills. How fair is that to me? I work hard there every single day.”

Rachel Allard, a nurse at Parsons Hill, said she has medical bills that are well over a year old and she’s had at least one therapist refuse an appointment because of unpaid medical bills.

Allard has become a point person at the facility in helping others with their insurance issues and trying to talk to Athena’s corporate officials.

“They keep saying they are working on it, but they still aren’t paying our medical insurance bills here,” she said.

Many employees get their care through the local UMass hospital and are having trouble getting appointments because doctors are reluctant to take Athena’s insurance.

Allard said some employees have contacted the Massachusetts Attorney General’s office and sent copies of overdue bills or notices from debt collectors.

“People are stuck either choosing to pay bills themselves because they need the medical attention or deal with constant harassment from debt collectors and the stress of not knowing if they can even go to their doctors,” she said.

‘It’s unimaginable’

Sen. Jorge Cabrera, co-chair of the Connecticut General Assembly’s Insurance and Real Estate Committee, was contacted by a former Athena employee in February about the payment issues.

“I worked full time for Athena Health Care Systems … During that time I was enrolled in the insurance program and had weekly deductions from my paycheck for that purpose,” the worker wrote in a letter to Cabrera. “Unfortunately, Athena has not funded the insurance program properly and is extremely delinquent in paying the insurance company. Therefore, the insurance company … has not paid my medical bills.

“I have received numerous medical bills of which I have no member responsibility and have had to start payment plans in order to avoid being sent to collections.”

The CT Mirror obtained a copy of the letter through a Freedom of Information Act request.

In an interview, Cabrera, D-Hamden, called the lapse “unacceptable.”

“It’s an awful situation,” he said. “They should pay the claims. That’s the bottom line. It’s unacceptable. I’m sure some people are delaying and forgoing care, and that’s dangerous for people’s health.”

Rep. Jane Garibay, D-Windsor, co-chair of the Aging Committee, said the non-payments send a bad message at a time when nursing home and home care agencies are desperately trying to recruit and retain staff. Connecticut’s aging population is estimated to grow dramatically in the coming decades.

“It’s unimaginable,” she said. “We have to find a fix for this in some way. We’re trying to attract workers. They should get what they were promised and not have to worry about going bankrupt because they can’t pay their medical bills or being unable to go to the doctor because they owe money that was not paid.”

Garibay said she hopes to explore legislation that further scrutinizes nursing homes’ use of taxpayer money.

The non-payment of health claims is one of several financial issues Athena has faced in recent years.

In 2022, Athena agreed to pay a $1.75 million fine to the Massachusetts Attorney General’s office for admitting people with substance abuse issues to its facilities without being able to provide appropriate treatment.

Six temporary employment agencies filed lawsuits against Athena in Connecticut, alleging the company failed to pay them more than $142,000 for employees they provided since 2021 to offset staff shortages. Another lawsuit claimed Athena owed nearly $2 million for temporary workers provided by a separate company. And an Iowa-based insurance company filed a federal suit alleging Athena failed to pay more than $6 million in health insurance claims from its employees, an issue that prompted state officials to contact the U.S. Department of Labor to investigate.

A federal judge in Iowa has ruled the case should be tried in state court. The lawsuit is pending in Connecticut, but the plaintiffs have asked the court to issue a direct verdict against Athena because the company has not responded to court filings. A judge has yet to rule on that motion.

Athena was being represented by Hartford-based law firm Murtha Cullina, but in March, the firm dropped out of the case because Athena had not paid the attorneys any money. Athena told the firm “it no longer has the funds” to pay for legal representation in the case, according to court records.

The company has also been cited over problems with staffing and patient safety in multiple states and has faced a wrongful death lawsuit .

In February, The CT Mirror reported that Athena owed more than $750,000 in overdue taxes, utility costs and interest on missed payments to municipalities.