Healthcare Advocate Saved Consumers $2.7 Million To Date

HARTFORD — State Healthcare Advocate Kevin Lembo announced November 4 that his office saved consumers $ 2.7 million through the third quarter of 2009. The office saved $700,000 for consumers in the third quarter alone.

Last year the Office of the Healthcare Advocate (OHA) saved consumers more than $5.2 million in denied claims or services by health insurance companies that were ultimately reversed in the consumers’ favor.

“Our office continues to provide the most cost-effective consumer assistance on health insurance issues in the state of Connecticut,” Mr Lembo said in a release. “The diligent staff, their dedication and personal attention to consumers, and their perseverance make a difference.”

While OHA does not measure the success of its efforts solely in consumer dollars saved, the office has a legislative policy function and works on state and federal health care issues that impact Connecticut’s health care consumers, the amount saved for consumers is an indicator of the level of demand for and success of OHA’s intervention.

Mr Lembo notes that year in and year out referrals to the Office of the Healthcare Advocate come from previous satisfied consumers of OHA services who go on to refer a friend or family member. So far this year his office has worked on 2,476 cases, and project a 50 percent year-end increase in cases over 2008.

“The true measure of our value comes from the repeat referrals we get from providers, legislators, and consumers who come away very happy with and thankful for our efforts,” he said. “We don’t win every case, but consumers know that when they come to OHA we exhaust all avenues to address their concerns.”

The state advocate expects the demand for the office’s individual case work to rise pending substantive health care reform.

“We are committed to bringing back to the legislature our long-advocated changes in state law on utilization review, as well as our initiative on postclaims underwriting, which protect consumers from unfair denials of coverage and rescission of their insurance policies,” Mr Lembo said. “These reforms are long overdue. It is long past time that the playing field is leveled to give patients and their families a fair shot when they go to battle with their insurer.”

Mr Lembo reminds health insurance consumers who are experiencing difficulties in getting needed health care, whether it is the inability to find a provider or the denial of medical or mental health or dental treatment, to call OHA at 866-466-4446 for free, real-time, confidential, expert assistance.