Healthcare Advocate Recovers $2.4 Million For Healthcare Consumers

Victoria Veltri, state healthcare advocate, announced that the Office of the Healthcare Advocate (OHA), the independent state agency that assists consumers with health insurance issues, generated $2.4 million in savings for Connecticut healthcare consumers in the second quarter of 2012. 

The savings figure represents the costs of healthcare services, procedures, and claims that would have been borne directly by consumers of healthcare had the agency not intervened and OHA’s 85 percent success rate in overturning insurers’ denials of health insurance coverage.

OHA’s case load volume remains at a two-year high. 

More than 20 percent of the volume of cases in the second quarter of 2012 was the result of the prolonged contract dispute between Anthem Blue Cross Blue Shield of Connecticut and the Connecticut Children’s Medical Center. OHA also experienced a high volume of education and counseling matters, reflective of the changing healthcare environment in Connecticut.

Denials of coverage for mental health and substance use treatment continue to dominate OHA’s case volume.

“OHA is committed to ensuring that insurance companies are held accountable to their consumers for ensuring access to care and coverage — coverage that consumers pay for in their premium dollars — for medically necessary treatment under state and federal mental health parity laws and grievance and appeals regulations,” she said.

“The situations consumers are experiencing require that we take action immediately to address the broken mental health delivery system for privately insured Connecticut residents,” she added.