Healthcare Advocate Recovers Record $6.4 Million

In First Half Of 2011

HARTFORD — Victoria Veltri, state healthcare advocate, announced that the Office of the Healthcare Advocate (OHA), the independent state agency that assists consumers with managed care insurance issues, generated $3.1 million in savings for Connecticut health care consumers in the second quarter of 2011. The savings figure of $3.1 million, in addition to the $3.3 million generated in the first quarter of 2011, represents the costs of health care services, procedures and claims that would have been borne directly by consumers of health care, had the agency not intervened.

Thus far in 2011, OHA has recovered more savings for consumers than it did in the entire calendar year of 2010. Second quarter 2011 savings more than quadrupled those of the same quarter last year. Case load at the office for the first half of 2011 has also doubled over the first half of 2010.

“We are experiencing a huge surge in caseload this year; state law requires insurers to provide OHA’s contact information on denial notices, so that consumers can have easy access to our free and effective services. Federal law also requires self-insured plans to include OHA’s contact information on denial notices,” said Ms Veltri.

OHA’s unique model of delivering real-time services for health care consumers includes direct intervention with and assistance from health care providers in advocacy with insurers, public and private, on denials of coverage for medical necessity, experimental/investigational status, and nonmedical necessity issues such as billing or coding errors and noncovered services determinations. OHA staff prepares cases thoroughly for appeals and appears in-person to advocate for consumers at administrative appeals.

“Continued support from the governor, the lieutenant governor, and the General Assembly, and a federal grant to provide direct consumer assistance and expanded outreach activities, have allowed OHA to provide its hallmark one-to-one consumer advocacy through rough economic times,” Ms Veltri added.

The consumer savings thus far represent only one facet of OHA’s work. OHA’s nine staff spends significant time disentangling the complexities of health insurance for consumers through assistance with plan selection and education and outreach on consumer health care rights.

OHA’s success has made it the model health insurance consumer assistance program for the US Center for Consumer Information and Insurance Oversight consumer assistance grant program. “OHA is the federally designated health insurance assistance program for the state of Connecticut,” Ms Veltri explained. “We earned that designation by putting all of our efforts into helping each and every individual consumer that contacts us, and holding managed care organizations accountable for their decisions.”

The designation requires that both state-licensed insurers and self-funded health plans must provide OHA’s contact information on any denial notices so that consumers can contact OHA for assistance.

Ms Veltri stated that OHA is funded out of the state Insurance Fund through assessments on the state’s insurance companies. The agency is not funded with taxpayer dollars.

“OHA’s consumer savings are an engine that provides a direct injection of revenue to the economy — consumers, providers, hospitals — that maximizes and ensures the value of employer, state, and privately purchased health insurance,” Ms Veltri said, adding that OHA is probably the best model of efficiency in state government. “In one half of the fiscal year we already paid for entire budget over five times over by returning such large recoveries to consumers and providers with a small [nine-member] staff.” 

At the same time, OHA continues to be a premier resource for Connecticut’s federal delegation on health care issues and other states that are developing their consumer assistance programs.

Ms Veltri says that a major goal for 2011 is to get the message to health insurance consumers about their new health care rights under federal health care reform and state law and to remind them that they can turn to OHA if they need help. OHA will continue to intervene in issues where systemic advocacy is needed, including participation in related health care activities such as the Connecticut Health Insurance Exchange Board and Planning Committee and the SustiNet Cabinet to ensure meaningful access to quality health care to all residents.

For free assistance, consumers can call 866-466-4446 or e-mail OHA at healthcare.advocate@ct.gov. For general information, Ms Veltri recommends that consumers visit OHA’s website at www.ct.gov/oha.