Ct Healthcare Advocate Recovers $2.5 Million For Consumers In First Quarter 2013

April 8, 2013
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Victoria Veltri, State Healthcare Advocate, announced today that the Office of the Healthcare Advocate (OHA), the independent state agency that assists consumers with health plan issues, generated $2.54 million in savings for Connecticut healthcare consumers in the first quarter of 2013.  The $2.54 million represents the costs of healthcare services, procedures and claims that would have been borne directly by consumers of healthcare, had the agency not intervened.

OHA’s model of delivering real-time services for healthcare consumers includes direct intervention via advocacy with health plans on denials of coverage for medical necessity, experimental/investigational status, and non medical necessity issues such as unwarranted billing actions or coding errors and non covered services determinations.  OHA works solely on health issues, and its consumer recovery total reflects savings from intervention in fully-insured and self-funded health plans. 

The $2.54 million savings total includes OHA’s successful appeals of several high dollar value, complex mental health treatment denials of medically necessary inpatient psychiatric care for adolescents and several complex medical cases.  The total nearly matches OHA fiscal year budget, and including savings from previous quarters, the savings total for the current fiscal year thus far is two and a half times OHA’s current budget.

In the first quarter of 2013, OHA’s savings total under its recently begun partnership with the Department of Children and Families (DCF) surpassed $2 million.  The partnership ensures that services for children whose parents have private health coverage are covered under private coverage before the state pays for services. 

In the first quarter of 2013, OHA opened 1577 cases, putting the office on course for a record year of case volume.  OHA also closed 1685 cases in the first quarter.  In addition to direct advocacy, OHA also:

·        Released a comprehensive report on barriers in access to mental health and substance   use prevention and treatment services in Connecticut

·        Conducted 63 outreach events for hundreds of people with community organizations, small businesses, town health departments and provider groups

·        Conducted webinar trainings for providers on the Affordable Care Act

·        Launched the navigator and in-person assister outreach and enrollment program under the ACA, designed to enroll and engage hundreds of thousands of uninsured residents in healthcare coverage

·        Conducted media campaigns attracting new customers to OHA for assistance in understanding their healthcare rights

Veltri said, “With health reform evolving, and open enrollment for the Exchange and Medicaid expansion imminent, the demand for the kind of services we provide, which range from consumer education and assistance in selecting a plan to direct advocacy in the appeal process, will skyrocket. 

“As OHA takes on the role of administering the navigator and independent assister program for the Exchange, it will be critical to have sufficient resources in place at OHA.  OHA is the federally recognized consumer assistance program under the Affordable Care Act, and therefore, OHA will play a key role in outreach, education and advocacy for new enrollees in 2014.  OHA is expected to receive a substantial number of referrals for consumer assistance beyond its existing case volume.”

Consumers who need assistance can call 1-866-466-4446, or e-mail OHA at healthcare.advocate@ct.gov

For general information, Veltri recommends that consumers visit OHA at www.ct.gov/oha,

at https://www.facebook.com/pages/State-of-Connecticut-Office-of-the-Healthcare-Advocate/301102456997?ref=hl and on YouTube at http://www.youtube.com/user/stateofctoha.

 

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