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.
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(Sorry - no podcast available for this
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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
Return to Main List
of Columns
© 2010 Trisha Torrey
No material found in this
website
is to be reproduced
without
expressed written consent of the
author.
..........
Trisha Torrey is Every Patient’s
AdvocateTM.
She offers no medical advice,
but empowers those who
want to learn more about
diagnosis and treatment options
by
providing useful tools and
resources.
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