New Report Shows Health Care Bureau’s Free Investigative Helpline Resolved Approximately 3,000 Cases For New Yorkers Improperly Billed And Denied Benefits In 2016
New York, NY - April 19, 2017 - Attorney General Eric T. Schneiderman today released a report detailing the work of his Health Care Bureau’s Helpline, a free service offered by the Office of the Attorney General that has investigated and resolved nearly 3,000 consumer complaints during the past year – saving or returning approximately $3 million in health care expenses to consumers. The service has also helped countless New Yorkers access medically necessary care or prescription medication previously denied to them.
“I’m proud of the free, vital service our Health Care Helpline provides to New York families. By intervening in claims to ensure timely, adequate, and cost-effective care, our Helpline advocates have saved New Yorkers millions of dollars – while helping ensure that New Yorkers have access to critical medical care they need,” said Attorney General Schneiderman. “As uncertainty surrounding the future of health care grows, New Yorkers can rely on our Health Care Helpline to protect their rights as health care consumers and guard against predatory medical practices.”
The Health Care Bureau’s 2016 Annual Report, Real Solutions for Real New Yorkers, details the work of Helpline advocates to resolve consumer complaints, as well as major cases handled by the bureau.
The Attorney General’s toll-free HCB Helpline – 800-428-9071 – is available for New Yorkers to report and resolve health care complaints and concerns ranging from simple payment processing errors to complex deceptive business practices. Consumers can also use the Attorney General’s online complaint form to lodge a complaint.
During 2016, Helpline staff resolved 2,917 consumer complaints and provided another 2,773 consumers with information or referred them to an appropriate agency for assistance. These consumer complaints include issues such as incorrect medical billing, wrongful health plan rejection, improper processing of health insurance claims, and wrongful termination of health insurance.
In one case, a consumer contacted the Helpline because she was being billed more than $45,000 by an air ambulance company and her health plan had only contributed $6,000.
After a Helpline advocate intervened, the health plan and air ambulance company agreed to an amount to settle the claim, reducing the consumer’s responsibility to approximately $2,000.
In another case, a consumer contacted the Helpline because her health plan denied coverage for prescription medication based on a determination that the medication was experimental. Once a Helpline advocate intervened, the plan paid nearly $22,000 for the consumer’s medication, leaving the consumer with only her standard copay.
While not all complaints can be resolved favorably, the Helpline can often provide reliable, objective information. Additionally, Helpline advocates work to ensure that any negative effects from improper medical billing or insurance claims are removed from credit reports.
The complaints handled by the Helpline highlight the challenges faced by New York health care consumers and are an important means of identifying systemic problems in New York’s health care system. Often these complaints provide the basis for further investigation and enforcement actions. For example, after receiving consumer complaints about health plan restrictions on coverage for treatment of Hepatitis C, the AG’s Health Care Bureau opened an investigation into New York health plans, which resulted in agreements with nine companies: Affinity Health Plan, Empire BlueCross BlueShield, Excellus Health Plan, Capital District Physician’s Health Plan (CDPHP), HealthNow, Independent Health, UnitedHealthcare/Oxford, MVP Health Plan, and Crystal Run Health Plans. The nine plans agreed to revise their coverage policies for chronic Hepatitis C treatment. As a result of these agreements, nearly all commercial health insurance plans in New York State cover treatment for chronic Hepatitis C without requiring members to develop advanced disease, such as liver scarring, and will not deny coverage because the member uses alcohol or drugs, or because the authorizing physician is not a specialist.
For more information about services provided by the Attorney General’s Health Care Bureau Helpline, click here.
The Health Care Bureau is led by Bureau Chief Lisa Landau, and the Helpline is overseen by Adrienne Lawston. The Health Care Bureau is part of the Social Justice Division, which is led by Executive Deputy Attorney General Alvin Bragg.
Consumers who believe that they may have been treated unfairly by a health care provider, HMO or insurance plan, or health-related business should call the Attorney General’s Health Care Helpline at 1-800-428-9071.