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Health Care Helpline recovers nearly $2M in restitution and savings for consumers

STAFF REPORTS


NEW YORK - 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 over 2,500 consumer complaints during the past year – saving or returning almost $2 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 they have access to the 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 and guard against predatory medical practices."

The Health Care Bureau's 2017 Annual Report, Real Solutions for Real New Yorkers, details the work of Helpline advocates to resolve consumer complaints, and discusses some of the 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 2017, Helpline staff handled 2,515 consumer complaints and provided another 3,050 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 $24,000 by a hospital for the care of one of her twins after birth.  After a Helpline advocate intervened, the denial of coverage was reversed.
  • In another case, a consumer contacted the Helpline regarding her health plan's denial of  coverage for prescription medication for her son who was taking a particular medication (Quillivant XR) that, after trying other medications, was the only medication that successfully treated the son's ADHD.  The consumer's request was particularly urgent because the health plan had denied continuation of the prescription as not medically necessary, leaving the child without medication for almost two weeks.  Once a Helpline advocate intervened, the medication was approved. 
  • A consumer contacted the Helpline because while the health plan agreed to pay in full for the consumer's gender reassignment surgery, the plan only paid half. After a Helpline advocate filed an inquiry, the plan paid in full as agreed. The Helpline advocate also discovered that the consumer had to pay out-of-pocket for other covered procedures that the health plan denied coverage for. The Helpline advocate filed a second inquiry, and the denial of coverage was reversed. Restitution to the consumer totaled $9,700.
  • After receiving a complaint that Brooklyn Hospital Medical Center had illegally billed a sexual assault survivor seven separate times for a forensic rape exam (FRE) administered in the hospital's emergency room, the HCB conducted an investigation that found that in 85 out of 86 cases between 2015 and 2017, the hospital either improperly billed the patient directly, or billed the patient's insurance plan without advising the patient of the choice of payment options as required by law. After these revelations, the Attorney General's office secured a settlement requiring Brooklyn Hospital to pay restitution to improperly billed survivors, maintain and properly disseminate a Sexual Assault Victim Policy that prevents improper billing, and pay $15,000 to New York State. The investigation also led to HCB's statewide investigation of improper hospital billing for FREs, which is currently underway.
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. These complaints often provide the basis for further investigation and enforcement actions. For example, after receiving a consumer complaint from an Oxford health plan member that she was receiving bills from a provider of infusion supplies, when the infusion supplies had previously been covered by her plan, the HCB conducted an expanded investigation of Oxford. As a result of the investigation, it was determined that a total of 2,587 claims were improperly denied, totaling nearly $500,000. Oxford agreed to reprocess the claims and pay providers where payment for claims were outstanding, and ensure restitution to consumers who had already paid providers. Oxford was also required to pay $35,000 to New York State.

For more information about services provided by the Attorney General's Health Care Bureau Helpline, click here.

Consumers who believe that they may have been treated unfairly by a health care provider, HMO or insurance plan, or health-related business should contact the Attorney General's Health Care Helpline by either calling the Helpline at 1-800-428-9071, or by submitting a complaint form online or by mail.  Instructions for submitting a complaint form by mail are also provided on the website.