February 07, 2006
CONSUMER PROTECTION WEEK INFO:
WHAT TO DO WHEN YOUR HEALTH INSURER REFUSES
TO COVER YOUR TREATMENT
As part of National Consumer Protection Week, Maryland Attorney
General Joseph Curran is today alerting the public to the assistance
his office can provide consumers who have been denied coverage
by their health insurance carrier or HMO.
As health insurance becomes more complicated and
an increasing number of providers participate in managed care
plans, the General
Assembly recognized it is crucial that consumers receive assistance,
when needed, in obtaining the coverage benefits promised by their
carrier or HMO. For that reason, it set up the Health Advocacy
Unit in the Attorney General’s office and provided an easy
means for consumers to contact that office – by either making
a phone call (1-877-261-8807, toll-free in Maryland) or filing
a complaint online at www.oag.state.md.us/Consumer/HEAU.htm.
Here are some examples of the types of complaints that are filed
with Attorney General Curran’s office:
A Baltimore woman with bone cancer learned that her health plan
would not pay for a stem cell transplant. The plan said that
since she was in remission after undergoing chemotherapy the
transplant was not necessary. But her doctor said that such transplants
can only be done during remission and that without the procedure
the cancer would probably recur.
An Eastern Shore woman's doctor ordered an echocardiogram to diagnose
her heart problem, but her health plan refused to pay for it, saying
that cardiac catheterization was sufficient.
Another woman's health plan would not pay for her prescription
for a certain ulcer medication. The plan would pay for alternative
medications, but she had tried them and they were not effective.
Fortunately these three patients filed a complaint with the Health
Education and Advocacy Unit and were able to get their health plans
to pay for the treatments they needed.
Help for Other Healthcare Disputes
The Health Education and Advocacy Unit does more than help consumers
with appealing denials by their HMO or health carrier. It also
billing disputes with hospitals, doctors, dentists, nursing
homes and counselors
refunds of money paid for health care goods or services
copies of their medical records or make corrections to them
warranty problems with hearing aids, eyeglasses, wheelchairs
or other medical equipment that is defective or was never delivered
payment plans or qualify for charity care.
How to Contact the HEAU
Hotlines:1-877-261-8807 toll-free in Maryland or (410) 528-1840
Fax: 410-576-6571 Address: Health Education and Advocacy Unit Office
of the Attorney General, 200 St. Paul Place, Baltimore, MD 21202
can also file complaints with the Health Education and Advocacy
Unit online at www.oag.state.md.us/Consumer/HEAU.htm/