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 help consumers:

• resolve billing disputes with hospitals, doctors, dentists, nursing homes and counselors
• receive refunds of money paid for health care goods or services
• receive copies of their medical records or make corrections to them
• resolve warranty problems with hearing aids, eyeglasses, wheelchairs or other medical equipment that is defective or was never delivered
• establish 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

Consumers can also file complaints with the Health Education and Advocacy Unit online at www.oag.state.md.us/Consumer/HEAU.htm/