NAPLES — AVOW Hospice laid off 23 employees in early November because of the tough economy and now there’s a lingering issue regarding the terminated employees’ ability to obtain health insurance coverage under the federal COBRA program.

Officials with AVOW, formerly Hospice of Naples, say they have no knowledge that former employees have not been able to enroll in COBRA, which they are entitled to, while a close relative of one of the former employees says she knows of two instances where that has been the case.

“Both of the people had the same issues,” said Mary Lesperance, a nurse who lives in Jacksonville. “My relative is still waiting for COBRA eight weeks later. It took a month for the application.”

Lesperance said her relative, who was in management at AVOW, and the other former employee in a similar COBRA predicament do not want to be interviewed or identified because they are looking for new jobs in Naples.

Another issue is that the affected employees were not told that their insurance with AVOW was terminated on the same day they were let go, on Nov. 3, according to Lesperance. Again, hospice officials disagree.

“We gave them a letter that explained their coverage ended and they are eligible for COBRA,” said Vivian Seely-Troiana, the human resources director at AVOW, adding that she had not heard from any former employees that they have not been unable to get COBRA coverage.

John Kern, an insurance broker with the Orlando-based firm, Lassiter-Ware Insurance, which handles AVOW’s insurance, said getting enrolled in COBRA can be a tedious process. Their third-party administrator for the coverage is Ceredian Corp.

“It can take 70 to 80 days in the process before the terminated employee is offered COBRA benefits,” he said, pointing out that once someone becomes eligible and enrolls, the COBRA coverage goes back to the date of when the employee left his or her job so back claims are paid.

Kern also said AVOW “did everything right” in informing the employees who were being let go that their AVOW insurance coverage with United Healthcare was being stopped.

Karen Rollins, AVOW president and chief executive officer, said it’s been a standing policy of AVOW to stop insurance coverage on the last day of someone’s employment with the hospice.

“That’s been our policy for many years,” she said.

Lesperance said that came as news to her relative, who worked at the hospice for five years. She learned she was no longer covered when she went to the pharmacy, the same evening she was let go, to pick up a prescription. She couldn’t pay for the prescription because of the cost and had to go to another pharmacy later for the generic version.

“I don’t believe it is accurate from what I have heard,” Lesperance said, referring to the AVOW policy. “They were specifically told it was canceled on (Nov. 3) at the pharmacy.”

The 23 job cuts crossed all departments in management, administration, and clinical fields, taking AVOW’s work force from around 150 employees down to 122 employees, Rollins said.

The job cuts were necessary because of a slowdown in patient census, from a year ago of 260 patients to 165 patients this month, Rollins said.

Rollins said other factors are increasing expenses, Medicare payment delays, fewer charitable donations coming in and the new hospice provider, VITAS Innovative Hospice Care, which began seeing its first patients in June.

AVOW has lost $1 million in revenue this past year and projects next year’s revenue at $14.5 million, Rollins said. A peak revenue when the Naples hospice business was in better shape was $20 million, she said.

Mark Cohen, spokesman for VITAS, said his company has about 20 patients in Naples since starting home-based care services this past summer and is “not big enough to cause (AVOW) to do significant layoffs.”

On the other hand, there is no doubt that charitable giving to nonprofit healthcare organizations, like AVOW, is down due to the recession.

In addition, hospice organizations are now having to discharge more patients who may not be getting recertified to continue receiving hospice care under increased Medicare scrutiny, he said.

“This is the first recession where health care is losing jobs hand over fist,” he said.

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