Teresa Schlintz, a former LHI employee who was with the company for four years and used to be Maxwell's case manager, said: "I realized Kevin's health was hurting because he was in the program. The promises kept getting broken one after another, and they were groveling for benefits."
Schlintz was terminated this year on the grounds that her return date from mental health leave was indefinite.
As the couple fielded calls from debt collectors, they said, a representative of LHI told them that their X-ray claim had been rejected because of a coding error. Eventually the provider wrote off the bill as a bad debt.
Eight other members said they have dealt with collection agencies or providers threatening to send bills to collection agencies over services they thought the program was covering.
A spokesperson for the WTCHP said that providers sometimes bill members by mistake and that "while there are things [LHI] can do to educate the providers ... the error is ultimately the provider's."
Michael Bergman, a clinical psychologist based in Austin, Texas, who treats a former volunteer responder, said, "First responders in general deserve a hell of a lot better than this company is providing."
In addition to other members' being left in the lurch, he and Authier have both gone at least six months unpaid by the program on two occasions, causing them to consider breaking their contracts with LHI.
"Twelve thousand dollars is not a drop in the bucket," Bergman said. "I need that money to pay my bills."
According to three former and one current employee, providers can be reluctant to serve members of the program because of the long billing windows, as well as a daunting amount of paperwork and low reimbursement rates.
'Under development'
Former and current employees said a major concern with both LHI and the WTCHP was the lack of priority placed on mental health support for members.
Members suffering from PTSD, anxiety, substance abuse and depression are eligible for psychological and psychiatric treatment through its funds, but the "Mental Health Care" part of the WTCHP's administrative manual — which details what services members are entitled to — has been "under development" since February 2020.
A WTCHP spokesperson said that LHI is able to raise any coverage questions during "weekly meetings" and that it is aware of the program's mental health policies.
When Young, the LHI case manager, tried to advocate for a member to get access to outpatient psychological treatment, she said, the current medical director admitted to having no background in mental health.
"I brought it up at case rounds, and the director said: 'I don't know anything about standards of care for mental health. Is this typical for that kind of case?'" Young said.
The program doesn't mandate that the medical director have mental health expertise, given that the position "covers a wide array of conditions," the spokesperson said.
Former and current LHI employees said staff training lacked any significant focus on how to handle traumatized populations, who they said often make up the bulk of a case manager's day.
"I did not have nearly enough training in order to appropriately handle calls that were escalated from members who are battling PTSD," said Ciera McCormick, a former LHI employee who worked in the case management team for about 18 months. "All I could do was offer a listening ear."
McCormick quit last month because of the toll it took on her mental health, which she said was worsened by such cases as a cancer-stricken member whose teeth were removed eight months ago and has yet to receive dentures because LHI can't find a provider.
Michael Gavin, a former Boston paramedic and 9/11 responder who suffers from severe PTSD, said his interactions with the program have led him to a breaking point. "I'm drinking myself to death, and I'm pretty much at the end of my rope," Gavin, 57, said in a voicemail to LHI that he shared with NBC News. "I don't know what I'm going to do."
"My PTSD is enraged right now," Gavin said on another phone call with LHI about a bill for which the program denied coverage.
In June, LHI informed Gavin was that he was being placed on a "behavioral contract," requiring that he interact respectfully with LHI staff members or risk being able to communicate with the program only in writing. The agreement, reviewed by NBC News, threatens to suspend his care if he continues to exhibit "disruptive and abusive behavior."
The move seems at odds with the program's original intention, because Congress mandated that members can be disenrolled only if they joined the program fraudulently or if they choose to leave.
"This program became your abuser," Schlintz recalled telling Gavin after she left the company.
In a statement, a WTCHP spokesperson said that the program will disenroll only members who don't meet eligibility requirements and that LHI "uses their institution's protocols to address behavioral issues."
'I don't need their thanks'
In addition to member complaints that the program isn't doing what it was meant to, another hurdle is looming: namely, money.
The WTCHP was supposed to be funded by Congress until 2090, but the office of Rep. Carolyn Maloney, D-N.Y., said it estimates that the program will be strapped for cash by 2025. Maloney, along with Reps. Jerry Nadler, D-N.Y., and Andrew Garbarino, R-N.Y., have introduced a bill to address the projected $2.6 billion shortfall.
Meanwhile, LHI's contract, which renews every five years, expires this month. Proposed changes in the contract by the National Institute for Occupational Safety and Health seem to address several of the frustrations members have been voicing. The new contract will require that members' calls be picked up within 20 seconds, that regional case managers be hired to address "unique locality needs" and that members get exams in a timelier fashion.
At a time when emotions are high for the community, members hope for more than empty words.
"It's funny. They end every phone call with 'Thank you for what you did,'" Michael Day said. "I don't need their thanks. I was doing my job. I want them to do their job."
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