Finding Help for Your Healthcare System Complaints
Note to readers: Since these articles are reprints of my newspaper column which is published in the Syracuse (NY) Post Standard, the focus for this piece is on NY. See links below for ways you can get help in your state.One patient needed breast cancer surgery and learned her insurance would cover the cost of reconstruction for one breast, but not the other.
Another patient complained that his hospital bill included items his insurance company had already paid for.
Still another needed a hernia operation. It was denied by his HMO.
What do all these situations have in common? They have all been resolved by the New York State Health Bureau.
The Health Bureau may be one of New York’s best kept secrets. Originally established by then-attorney general Eliot Spitzer, the Health Bureau has been handling complaints, watching for trends, and improving the healthcare landscape for New Yorkers for more than a decade.
Today, despite the mess in Albany over budgets and politics, Attorney General Andrew Cuomo continues to keep the Health Bureau funded and operational – a real boon to patients who face challenges with the healthcare system.
The Bureau’s services are provided by a group of patient advocates – people whose only job is to help us get past treatment and test denials, or fight errant insurer and provider billing practices. According to Health Bureau Chief James Dering, these advocates have saved families and prevented bankruptcies by making sure insurers and providers met their obligations.
In the bigger picture, the Health Bureau looks for problematic trends. For example, dozens complained about outrageous charges for visiting doctors who were not included in their insurer’s network. Health Bureau attorneys discovered that the rate schedule being used by their insurance companies was based on a database put together by a company called Ingenix, supposedly an independent rate setting entity. They then learned Ingenix was owned by United Healthcare – one of the largest health insurers in the country -- meaning it was not so independent after all. Today the Attorney General’s office is developing a new, objective rate database to be used by insurers across the country.
A Health Bureau advocate may be able to help you with almost any type of complaint about the healthcare system, whether or not your complaint relates to money. Insurance denials, billing, pharmacy costs, even complaints about an individual doctor or healthcare facility. If the complaint is not something they handle, they will refer you to the right people.
If you have a complaint about an insurer, provider or facility in New York State, contact the Health Bureau at 1-800-428-9071 or use their complaint form.
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Need to find help for health system problems in your state?
For problems with your care, you may want to hire a private advocate to help you: www.AdvoConnection.com
For review of medical bills, including hospital bills, ask a claims specialist to help.
If you need help fighting an insurance denial, you'll need to find someone who specializes in working with insurers and other payers.
To find any help your state may assist you with:
In your favorite search engine, search using these terms:
(Your state name), health department, (your problem), complaints
Examples:
Georgia, health department, doctor complaint
or
Texas, health department, insurance complaint | 
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Trisha Torrey
is the author of
You Bet Your Life!
The 10 Mistakes
Every Patient Makes
(How to Fix Them
to Get the
Health Care You Deserve)
It expands on the articles found
on this site, providing an
exposé of the problems that
exist in the healthcare system,
and tools you can use to get the care you deserve.
....
Learn more about
You Bet Your Life!
........................
Do you need help with your
medical care, insurance or
healthcare bills?
A patient advocate may
be able to help.
Advocates and patient navigators
are ready to help you at
AdvoConnection.
Search for the help you need
at no cost to you. |
