New Report Shows Health Care Bureau’s Free Investigative Helpline Handled Almost 2,000 Cases for New Yorkers Improperly Billed and Denied Benefits In 2018
Attorney General Letitia James today released a report detailing the work of the Office of the Attorney General’s Health Care Bureau’s Helpline, a free service offered by the office that handled almost 2,000 consumer complaints during the past year – saving or returning more than $2.3 million in health care expenses to consumers. The service has also helped countless New Yorkers access medically necessary care or prescription medication previously denied to them.
“Health care is a basic right that all New Yorkers should have access to,” said Attorney General Letitia James. “This hotline has been an invaluable tool in helping us protect New Yorkers and ensure that they get the care they deserve and are not taken advantage of. If you believe you are being improperly billed or denied health care benefits, I urge you to reach out to our office for support."
The Health Care Bureau’s 2018 Annual Report, Real Solutions for Real New Yorkers, details the work of Helpline advocates to resolve consumer complaints, and discusses some of the major cases handled by the bureau.
The Attorney General’s toll-free HCB Helpline – 800-428-9071 – is available for New Yorkers to report and resolve health care complaints and concerns ranging from simple payment processing errors to complex deceptive business practices. Consumers can also use the Attorney General’s online complaint form to lodge a complaint.
During 2018, Helpline staff handled 1,961 consumer complaints and provided another 2,389 consumers with information or referred them to an appropriate agency for assistance. These consumer complaints include issues such as incorrect medical billing, wrongful health plan rejection, improper processing of health insurance claims, and wrongful termination of health insurance.
- In one case, a consumer contacted the Helpline because she was essentially homebound. The company she had sent her wheelchair to for repair more than five months earlier had not returned the chair. After a Helpline advocate intervened, the repair company delivered the wheelchair to the consumer in less than a week after she contacted the Helpline.
- In another case, a consumer contacted the Helpline regarding her health plan’s denial of coverage for a drug recently approved by the FDA to treat Hodgkin’s lymphoma. Once a Helpline advocate intervened, the medication was approved.
- A consumer contacted the Helpline because her health plan paid for the surgery for implantation of a loop recorder that was recommended by her cardiac specialist to monitor her heart, while denying coverage of the actual recorder as experimental/investigation, leaving the consumer with a bill for over $11,000. The health plan reversed its denial of coverage after the Helpline advocate’s intervention.
- After receiving a complaint that EmblemHealth improperly denied coverage of gender reassignment surgery to a member based on failure to meet EmblemHealth’s unlawful criteria, the HCB conducted an investigation finding that EmblemHealth’s Gender Reassignment Guidelines were outdated and not evidence-based during the time they remained in effect, and that Emblemhealth provided misleading and deceptive information to plan members indicating that the Guidelines were based on current clinical information and standard medical guidelines when they were not. As part of a settlement agreement, EmblemHealth updated its Gender Reassignment Surgery Guideline and agreed to provide restitution to members improperly denied coverage for gender reassignment surgery, and pay $250,000 in civil penalties to New York State.
- As a result of last year’s benchmark settlement with The Brooklyn Hospital Medical Center (“Brooklyn Hospital”), which was initiated after the HCB received a complaint that a survivor of sexual assault was billed seven separate times for a forensic rape examination (“FRE”) administered in Brooklyn Hospital’s emergency room, the HCB initiated an ongoing investigation into the improper billing practices of New York hospitals for FREs. This ongoing investigation has led to agreements with six New York hospitals and a university to pay restitution to patients and change billing procedures for FREs. The facilities include Brookdale University Hospital Medical Center, Columbia University, Montefiore Nyack Hospital, New York Presbyterian/Brooklyn Methodist Hospital, New York-Presbyterian/Columbia University Irving Medical Center, Richmond University Medical Center, and St. Barnabas Hospital. The investigation found pervasive failures to advise patients of their payment options, and widespread unlawful billing of sexual assault survivors. The ongoing investigation has already revealed at least 200 unlawfully billed FREs at the seven settling hospitals. Under the terms of the agreements, the hospitals will implement written policies to ensure that sexual assault survivors do not receive bills for their FREs, provide full restitution to any improperly billed sexual assault survivors, and pay costs.
While not all complaints can be resolved favorably, the Helpline can often provide reliable, objective information. Additionally, Helpline advocates work to ensure that any negative effects from improper medical billing or insurance claims are removed from credit reports.
The complaints handled by the Helpline highlight the challenges faced by New York health care consumers and are an important means of identifying systemic problems in New York’s health care system. These complaints often provide the basis for further investigation and enforcement actions as indicated above in the EmblemHealth and New York Hospital FRE investigations.
Consumers who believe that they may have been treated unfairly by a health care provider, HMO or insurance plan, or health-related business should contact the Attorney General’s Health Care Helpline by either calling the Helpline at 1-800-428-9071, or by submitting a complaint form online or by mail. The online complaint form is easy for consumers to submit and can be accessed from the HCB website at the link provided here. Instructions for submitting a complaint form by mail are also provided on the website.
