We're In Your Corner
A Message from your Healthcare Advocate
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Welcome!
The Connecticut Office of Healthcare
Advocate works incredibly hard for our client families throughout the
year. We help them navigate, challenge and win complicated
healthcare insurance cases among many other advocacy and educational
efforts.
Once a year, we publish an annual report on all our efforts. I am happy
to share that OHA continues to make gains on behalf of our citizens.
We made every effort to provide quality advice and representation
to Connecticut individuals and families facing difficulties choosing or
enrolling in health insurance or facing health insurance denials. The
OHA staff, including nurses, paralegals, attorneys, consumer information
representatives and other professionals, fielded 2,215 calls or
complaints, and achieved consumer savings of over $5.3 million for the
residents of Connecticut, bringing the total consumer savings that OHA
has achieved since its inception in 2005 to over $117 million. You can read the OHA Annual Report here.
Despite COVID-19 restrictions and issues, we are further expanding our
outreach and education efforts for 2021, with several initiatives
planned or under way. We will be ramping up more online group
presentations and discussions and using our resources to contact various
networks to make sure we are helping as many people as possible.
As the pandemic recedes in the coming months, and more residents
pursue medical care and procedures, we expect the demand for our
services to increase.
You can count on us to be in your corner.
Ted Doolittle
Healthcare Advocate, State of Connecticut
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Colorectal Cancer Awareness
Colorectal
Cancer Awareness - There is always good news and heartbreak when we
talk about cancer. What's positive is that the death rate from various
cancers are on the decline but the heartbreak is that there are still
more than 600,000 people who will die this year from cancer. Death rates
are higher for some cancers and in some racial/ethnic minority groups.
These disparities are often linked to social determinants of
health, including education, economic status, and access to health care
according to the Office of Health and Human Services.
Never before have we been better equipped and able to identify and
achieve early detection than right now. There is extensive evidence
based intervention and screenings for lung, breast, cervical and
colorectal cancers that can help save lives and reduce cancer deaths.
These screenings are covered by your health insurance policies here in
Connecticut. Other effective prevention strategies include programs that
increase HPV vaccine use, prevent tobacco use and promote quitting, and
promote healthy eating and physical activity.
March is colorectal cancer awareness month. You can help save a life if
you pass this on and don't let yourself or your loved ones go without
well visit screenings. Find out more about colorectal cancer here.
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Public Option
If
you work for a non-profit or small business, you need to follow the
public option healthcare insurance legislation under discussion in the
capital. As you are likely aware, the OHA is keenly concerned about
rising healthcare costs, escalating premiums and lack of access to
medical care. There are two competing plans under consideration that
attempts to limit drug price increases, increase the subsidies to buy
insurance on the exchange and/or use the state's buying power to create
better policy pricing for non-profit and small businesses. This article is a good overview of the discussion and the key points of each proposal.
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OHA: We're in YOUR Corner
KD
reached out to OHA reporting although his first ever colonoscopy was
coded as preventative, the anesthesiologist at his colonoscopy coded
claims as diagnostic. This resulted in KD incurring a $708 medical bill
they were not expecting. KD’s account was placed into collections. OHA
outreached the provider, the out of state insurance carrier, and the
collections agency multiple times. The case was reviewed by the
carrier’s claims department and claims were adjusted to be preventative.
OHA requested written documentation of this outcome and when it was
received it was shared with KD. The provider was paid in full by the
carrier which left KD with a $0 balance, resulting in a consumer
savings of $708.00.
A consumer contacted OHA regarding a billing issue for a colonoscopy
test. Insurance company refused to pay hospital, doctor and
anesthesiologist bills because the doctor coded incorrectly. After
obtaining the required health information release, OHA sent Inquiry
to Carrier. Carrier responded indicating that claims were reprocessed
based on medical records from the Provider. Based on Case Manager
getting medical records reviewed claim was reprocessed resulting in a
savings to the consumer in the amount of $3,816.26.
A consumer contacted OHA regarding a billing issue where the insurance
carrier was not paying claims and they owed a large sum of money. The
case manager sent an inquiry to Carrier asking why the claims were not
being paid. The healthcare insurance carrier responded indicating claims
were being processed, but they had to wait for funds from a stop loss
carrier to pay claims. After several months of going back and forth with
the company, a successful response was finally received. The
Carrier provided evidence the claims were processed, paid and provided
all mailing tracking information, check numbers and the names of medical
providers who were paid. Savings: $143,848.46!
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Email Sign-Up
OHA
has saved consumers tens of millions of dollars since the agency was
launched - and we've become a trusted resource and consumer advocate on
all matters of healthcare insurance here in Connecticut and on
developments in Washington, D.C. that can affect us. We share these
changes and information in many ways - social platforms like our
page on Facebook
and Twitter, press conferences and via this newsletter. If you know
somebody who is not getting this newsletter on a regular basis - or is
only getting it because it's shared with them - OHA invites one and all
to join our exclusive email list. Sign up for the newsletter here.
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The OHA will help you during this crisis get you the assistance you need.
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Many other services are covered by the Department of Social Services (DSS).
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Compare the cost of non-emergent healthcare treatments before you get the bill.
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We invite you to visit our new website!
It can be found here: https://portal.ct.gov/oha
Notice the new address. It’s slightly
different than the old one but no worries if you happen to forget, it
will automatically redirect you to our new one. Read, enjoy, be informed
and know your rights and responsibilities in the fast moving world of
healthcare insurance. There are many helpful tips, links and great
information you’ll find useful.
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Our Mission
The mission of the Office of the
Healthcare Advocate (OHA) is to assist consumers with healthcare issues
through the establishment of effective outreach programs and the
development of communications related to consumer rights and
responsibilities as members of healthcare plans. OHA focuses on
assisting consumers in making informed decisions when selecting a health
plan; assisting consumers to resolve problems with their health
insurance plans and tracking trends of issues/problems, which may
require administrative or legislative intervention, or advocacy with
industry, the public, or other stakeholders
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