OHCA’s Jurisdiction

 

Section 19a-681(a) of the Connecticut General Statues requires hospitals to file their pricemaster with OHCA and 19a-681(b) states that a hospital shall be subject to a civil penalty of $500 for each occurrence which shall be imposed in accordance with Section 19a-653(b) and (e) if found not to be in compliance with Section 19a-681(b). A pricemaster is…

 

OHCA’s jurisdiction is limited to finding whether or not the pricemasters codes, description and prices on the hospital’s bill agree with the hospital’s pricemasters on file. Therefore, if you have a complaint or questions regarding the charges to the services provided to you at the Hospital please continue with the process by selecting the link Guidelines and Required Information and complete the Consumer Assistance Process Form (“CAP Form”).

 

The following matters are not under OHCA’s jurisdiction:

 

1.    Complaints dealing with issues of private (commercial) and non-private (government) health care benefits and coverage(more);

2.    Access of health insurance coverage for uninsured patients(more);

3.    Complaints dealing with the uninsured patients or guarantors who have already been turned over to collections(more);

4.    Private Physicians and Medical groups charges,  regardless of their affiliation with the hospital(more);

5.    Charges associated with services provided at an outpatient facility, regardless of their affiliation with the hospital (e.g. radiology offices, cardiac, ambulatory and sleep centers, private and public medical laboratories, etc.) (more);

6.    Private practice and Hospitals quality of care (more); and

7.    Access to Medical Records and licensing information (more).

 

(Note: the “more” link should take the consumer to “Related Links” where additional options on referrals to handle a particular complaint will be offered to the consumer).

 

Consumers with these types of questions should contact Hospital staff for assistance. Please refer to Connecticut Acute Care Hospitals’ Collection Policies and Procedures for detail information on the Hospitals’ collection practices and to Related Links for the Hospital’s and other state agencies contact information that will be most appropriate to handle the complaint.

 

For additional assistance on how to handle your complaint please refer to the site’s Frequently Asks Questions link.

 

Guidelines and Required Information

 

Consumer inquiries must be submitted to OHCA on the CONSUMER ASSISTANCE PROCESS FORM (“CAP Form”). Since, OHCA does not have jurisdiction to all issues related to Hospital services and billing we recommend consumers that prior to completing the Form to refer to OHCA’s Jurisdiction link first in order to determine if this agency is the most appropriate venue for them to direct their inquires.                           

 

To download the CAP Form select Word. The following requirements are necessary to be able to download the form: (Add the technical requirements)

 

If you are having problems downloading the form, a handwritten letter will be acceptable as long as it contains the same information requested on the form (see below for CAP Form sample). Make sure to provide us with all of the required information. Be aware that information missing on the form or the handwritten letter may delay the process of your inquiry.

 

Please submit the form or handwritten letter to:

 

Office of Heath Care Access (OHCA)

410 Capitol Avenue, MS#13HCA

P.O. Box 340308

Hartford, CT 06134

 

Make sure to include with the form a description of the complaint along with copies of all pertinent documents.

 

 

 

 

Sample-Consumer Assistance Form                                          

 

Date: _____________

 

First Name: ______________ Middle Initial: ____ Last Name: _____________

 

Address:

 

Street: ______________________

 

City, State, Zip Code: _______________________________________________

 

Email: _________________

 

Hospital Name: ____________________________________

 

Hospital Date(s) of Service: ___________________________

 

Have you contacted the Hospital?   Yes___   No___

If yes, provide a contact person and copies of any correspondence

 

Have you contacted any other State of Connecticut Agencies (i.e. Dept. of Insurance, Dept. of Public Health, and Office of Health Advocate)?  Yes___ No___

If yes, provide a contact person and copies of any correspondence

 

Does the Patient have insurance? Yes ___ No___, if yes, please choose one:   Medicaid ? Medicare ? Commercial ?

 

Bill status:  In Collection:  Yes ___ No___

Provide a copy of your itemized Hospital bill (with pricemaster codes)-needs definition 

 

Please attach a description of your complaint with the form;

 

Patient’s signature: ______________________    Date: _________________

 

If acting on behalf of the patient please indicate the following:

 

Name: ______________    Relationship to the Patient: _______________

 

Contact information:

 

Address: ___________________________________

 

Phone: __________________________

 

Email address (if available):_____________________

 

Signature: ____________________________

 

Patient’s Consent:

 

I ___ (Patient’s name) __________gives permission to ________________to act on my behalf in reference to this complaint submitted to the Office of Health Care Access.

 

Patient’s Signature: ______________________                         Date: _____________       

 

 

 

 

Patients’ Rights

 

Statutory References- PDF – (Aminur please see Form 1 attached)

 

Connecticut Acute Care Hospitals and Medical Centers Collection Policies and Procedures:

 

  1. William W. Backus Hospital

PDF

  1. Bridgeport Hospital

PDF

  1. Bristol Hospital

PDF

  1. Charlotte Hungerford Hospital

PDF

  1. Connecticut Children’s Medical Center

PDF

  1. Danbury Hospital

PDF

  1. Day Kimball Hospital

PDF

  1. Essent-Sharon Hospital

PDF

  1. John Dempsey Hospital

PDF

  1. Greenwich Hospital

PDF

  1. Griffin Hospital

PDF

  1. Hartford Hospital

PDF

  1. Hospital of Saint Raphael

PDF

  1. Hospital of Central Connecticut

PDF

  1. Johnson Memorial Hospital

PDF

  1. Lawrence & Memorial Hospital

PDF

  1. Manchester Memorial Hospital

PDF

  1. Middlesex Memorial Hospital

PDF

  1. MidState Medical Center

PDF

  1. Milford Hospital

PDF

  1. New Milford Hospital

PDF

  1. Norwalk Hospital

PDF

  1. Rockville General Hospital

PDF

  1. Saint Francis Hospital & Medical Center

PDF

  1. Saint Mary’s Hospital

PDF

  1. Saint Vincent’s Medical Center

PDF

  1. Stamford Hospital

PDF

  1. Waterbury Hospital

PDF

  1. Windham Community Memorial Hospital

PDF

  1. Yale-New Haven Hospital

PDF

 

 

 

 

 

 

 

 

 

 

Related Links

 

Hospitals Contact Information-PDF

 

State Agencies-PDF

 

Referrals by issue/complaint:

 

1.    Hospital Bills (need to add data)

2.    Charges related to services provided by health care providers other than Hospital. (need to add data)

3.    Health care coverage options(need to add data)

4.    Issues related to the quality of care provided by a hospital or a private practice. (need to add data)

5.    Access to health care facilities and services(need to add data)

6.    Medical Records and licensing information(need to add data)

 

 

Frequently Ask Questions

 

Q:       How do I know if I have been billed correctly by my hospital?

A:        As a consumer of health services, you are entitled to an itemized copy of your hospital bill that details all of the services and supplies that you received.  The line-item bill should outline every service provided, the date it was provided, and should include item and procedure codes.

 

Q:        What if I find that I am unable to pay my hospital bills?

A:        Many hospitals in Connecticut receive funds from the federal government and private donors to assist them in providing free or reduced cost care to needy patients.  Ask your hospital for information and assistance in applying for any such funds. 

 

Q:        With my existing health problems, where or how can I access affordable health insurance?

A:        If you are having trouble obtaining adequate health insurance, you may wish to contact the Health Reinsurance Association (HRA), a "high risk pool", at 1-800-842-0004.  This organization is mandated by the State of Connecticut to offer health insurance to any uninsured state resident nineteen years of age or older. 

 

Q:        My insurance company claims that the hospital’s charges are “above the usual and customary charges”.  Am I being overcharged by the hospital?

A:        Most fee-for-service health insurance plans base their reimbursement on a percentage of “usual and customary” charges, or on a percentage of the “prevailing rate” for services.  The information on which these charges and rates are based is not available to the public.  (However, each hospital’s rates are a matter of public record).  If your insurance company isn’t paying the submitted hospital charges because it claims that those charges are above the “usual and customary”, you may write the insurance carrier appealing for a higher reimbursement rate.  When making such an appeal to your insurance carrier, seek help and supporting documentation from the hospital and/or your health care provider.  

 

Q:        I am concerned about my physician’s fees and billing practices.  What recourse do I have?

A:        The State of Connecticut does not regulate private physician fees or billing practices.  If you are concerned about a billing problem, you must contact your physician directly.   However, if your concerns involved the quality of care your physician provided, you may contact:

State of Connecticut Department of Public Health
Division of Health Services Regulation
410 Capitol Avenue
MS #12HSR
PO Box 340308
Hartford, CT  06134

You may also call at (860) 509–7400.

 

Q:        I am having problems with getting my HMO to pay my bill.  Do I have any recourse?

A:        The Office of Health Care Advocate helps Connecticut consumers who have health insurance provided by a managed care organization (MCO).   Their website is. www.ct.gov/oha.