Office of Maryland Attorney General J. Joseph Curran, Jr.

June 13, 2000 Media Inquiries: Sean Caine 410-576-6357

In Response to Supreme Court Ruling, Curran Reminds Marylanders That His Office Can Assist
AG's Health Education and Advocacy Unit Mediates on Behalf of Marylanders

Baltimore - Attorney General J. Joseph Curran, Jr., reminded Maryland citizens today that there is still help for those whose HMOs have denied care or claims, despite a decision yesterday by the U.S. Supreme Court that patients cannot use a federal law to sue HMOs for giving bonuses to doctors who skip diagnostic tests and use other methods to cut treatment costs.

Curran's Health Education and Advocacy Unit assists patients in appealing denials of care by their HMOs and other health insurers. When a patient calls the Unit, mediators gather information from the health plan about the reason for the denial, then get information from the patient and the doctor about the patient's diagnosis and the need for the treatment that was denied. Working with the information and communicating with the parties involved, the Unit often gets the HMO to reverse its decision. If unsuccessful in obtaining a reversal, the Unit will help the patient file a formal appeal with the HMOs grievance process.

"Even though yesterday's Supreme Court decision may limit some private legal remedies, my office can still assist patients in getting the care they need," said Attorney General Curran. "We take very seriously our role as advocates for the citizens of Maryland and we want people to know that we are available and willing to help them."

Since January 1999, the Unit has assisted nearly 1,800 patients in challenging decisions. In about 75% of these cases the HEAU was successful in getting the HMO or other carrier to provide or pay for the services.

Patients who need assistance from the Health Education and Advocacy Unit can contact its toll-free number at 1-877-261-8807.