State Healthcare Advocate Records $2.9 Million

In Recovered Funds Last Quarter

HARTFORD — Victoria Veltri, state healthcare advocate, recently announced that her office, the independent state agency that assists consumers with managed care insurance issues, generated $2.9 million in savings for Connecticut health care consumers in the third quarter of 2011. The savings figure of $2.9 million 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 Office of the Healthcare Advocate (OHA) has recovered nearly twice as much in savings for consumers than it did in the entire calendar year of 2010, a record $9.3 million. And she said case load at the office for 2011 is trending toward more than double the case load of last year.

State law requires insurers to provide OHA’s contact information on denial notices, so that consumers can have easy access to OHA’s free and effective services. Federal law also requires self-insured plans to include OHA’s contact information on denial notices.

“While having OHA’s information easily available to consumers is something I’ve always equated to the adage, ‘If you build it, they will come,’ and they have, unfortunately we are not building a field of dreams,” Ms Veltri said. “We’re actually in the business of erasing some of the most complex health care problems that our fellow residents are facing, and in the process, restoring the ability for some to receive the care they need.”

Ms Veltri said demand for services keeps increasing, and her department is straining its resources to keep up.

“However, we know that this demand is only a fraction of the true need out there,” she added. “There are pockets of underserved communities that OHA is still working to reach, consumers who may have been wrongfully denied coverage for desperately needed medical and mental health services.”

OHA’s 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 unwarranted billing actions 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.

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.