Attorney General James’ Health Care Helpline Recovers More Than $1.5 Million in Restitution and Savings For New Yorkers

 

Free Helpline Handled More Than 2,300 Cases for New Yorkers with Health Care Complaints In 2022

New York Attorney General Letitia James today released a report detailing the work of the Office of the Attorney General’s (OAG) Health Care Bureau’s Helpline, a free service that handled more than 2,300 consumer complaints and recovered more than $1.5 million in restitution and savings for New Yorkers in 2022. The Helpline is also available to provide information to New Yorkers and ensure they can access medically necessary care or prescription medication unfairly denied to them.

“Access to health care is a fundamental right for every New Yorker,” said Attorney General James. “Through the critical work of our Helpline, we saved New Yorkers more than $1.5 million dollars last year, while helping to ensure people have access to the medical care they need. Anyone who believes they were wrongfully billed or denied health benefits are encouraged to contact my office for support.”

The Health Care Bureau’s 2022 Annual Report, Real Solutions for Real New Yorkers, details the work done over the past year to assist New Yorkers. The report highlights actions taken by Helpline advocates to resolve consumer complaints, discusses major cases handled by the bureau, and details health care concerns facing New Yorkers, including issues related to COVID-19. New Yorkers can call the toll-free Helpline at 1-800-428-9071 to report and resolve health care complaints and concerns ranging from simple payment processing errors to complex deceptive business practices. Consumers can also use OAG’s online complaint form to lodge a complaint. 

In 2022, Helpline staff handled 2,309 consumer complaints and provided another 1,722 consumers with information or referred them to an appropriate agency for assistance. Complaints addressed through the helpline include:

• Six consumers contacted OAG after receiving unexpected bills of $300 to $400 for office visits related to COVID-19 between 2020 and 2021, when their COVID-19 testing should have been free of charge. After OAG intervened, the patients’ balances were adjusted to zero.

• A consumer's infant was born prematurely with multiple complications, and needed a higher level of care that could only be provided at a children’s hospital. Their transfer request was initially denied by the health plan, but was then approved after OAG asked their health plan to review the medical necessity.

• A consumer received a bill for in-network services at a hospital that was nearly twice as much as the initial written estimate. After OAG got involved, the hospital issued a zero-balance statement, saving the consumer about $1,000.

• A consumer injured her foot and scheduled an appointment with an orthopedic surgeon, who required an MRI to determine the best course of treatment. Her health plan denied both the initial request for coverage and an appeal. After OAG intervened, the health plan approved coverage for the MRI.

• After receiving complaints about illegal billing practices at Mobile Life, an Orange County ambulance company, OAG conducted an investigation and found Mobile Life unlawfully billed patients for the difference between what their insurance plans paid and what the company charged. After these revelations, Attorney General James secured a settlement that required Mobile Life to pay restitution to the affected patients, update its billing practices, and pay a $100,000 penalty.

In addition to highlighting the challenges faced by New York health care consumers, complaints handled by the Helpline are also an important means of identifying systemic problems in the state’s health care system. While not all complaints and inquiries can be resolved favorably, the Helpline is a crucial source of reliable and objective information for New Yorkers. Helpline advocates also work to ensure that any negative effects from improper medical billing or insurance claims are removed from credit reports.

Any consumer who believes that they may have been treated unfairly by a health care provider, Health Maintenance Organization (HMO), insurance plan, or health-related business should contact OAG’s Health Care Helpline online or by calling 1-800-428-9071.

The OAG Health Care Bureau’s Helpline is part of Attorney General James’ ongoing efforts to safeguard New York consumers and ensure health care access is protected. Last month, Attorney General James issued a consumer alert to warn New Yorkers about a new health insurance renewal scam and provided important tips to protect them. In December 2022, Attorney General James warned New Yorkers about potential price gouging of children’s medication. In May 2022, Attorney General James helped ensure the completion of $13.6 million in payments to consumers who were unlawfully denied coverage under her landmark settlement with the nation’s largest health insurer, UnitedHealthCare. In February 2022, Attorney General James secured refunds for New Yorkers who were wrongfully charged administration fees from two New York City pharmacies when they received their COVID-19 vaccine.