OHA: OHA Recovers (YR 2012)


Office of the Healthcare Advocate News

Office of the Healthcare Advocate Recovers $6.3 Million for Healthcare Consumers in CY 2012

February 4, 2013 - HARTFORD, CT

Victoria Veltri, State Healthcare Advocate, announced today that the Office of the Healthcare Advocate (OHA), the independent state agency that assists consumers with health plan issues, generated $6.3 million in savings for Connecticut healthcare consumers in calendar year 2012. The $6.3 million represents the costs of healthcare services, procedures and claims that would have been borne directly by consumers of healthcare, had the agency not intervened. Despite the loss of two seasoned case managers, OHA was able to recover per case manager as much as it did last year.

OHA’s model of delivering real-time services for healthcare consumers includes direct intervention with and assistance from healthcare providers in advocacy with health plans on denials of coverage for medical necessity, experimental/investigational status, and non medical necessity issues such as unwarranted billing actions or coding errors and non covered services determinations. OHA works solely on health issues, and its consumer recovery total reflect savings from intervention in fully-insured and self-funded health plans.

OHA received two federal consumer assistance program (CAP) grants in 2012 under an Affordable Care Act (ACA), totaling nearly $530,000, allowing consumers the consistent resource of an independent office dedicated solely to consumer education and direct assistance with appeals and data collection. Because OHA is the federally designated CAP for Connecticut under the ACA, all self-funded and fully-insured plans must provide OHA’s contact information on every denial notice.

The CAP grants allowed OHA to provide direct assistance with caseload activities. They also funded: over 100 outreaches; television spots in English and Spanish airing in portions of the state—spots that will air in prime time slots in the spring of 2013 throughout the state—brochures in the twenty most spoken languages in Connecticut that explain new healthcare rights and OHA’s services; a thirty minute program airing on around the state and on OHA’s YouTube channel; multiple television and radio appearances to educate consumers on their healthcare rights and to direct them to our office with questions; an outreach campaign to small businesses to educate them about OHA’s services for them and their employees; and a partnership with a community non-profit organization to reach hundreds of community organizations and their members.

In 2012, OHA used its authority to facilitate comment on the implementation of federal and state laws to hold a hearing on access to mental health and substance use preventive and treatment services. The hearing resulted in a major report that will drive OHA forward in its efforts to assure consumer rights under federal and state laws are enforced.

OHA partnered with the Department of Children and Families (DCF) to ensure that services for children whose parents have private health coverage are covered under private coverage before the state pays for services. OHA also collaborated on a project with the Department of Social Services (DSS) to attempt to increase Medicaid recoveries under the Third Party Liability process.

Veltri says, "With health reform evolving and the exchange enrollment imminent, the demand for the kind of services we provide, which range from consumer education and assistance in selecting a plan, all the way through direct advocacy in the appeal process, will skyrocket. There are pockets of underserved communities that OHA is still working to reach, consumers who may have been wrongfully denied coverage for desperately needed health services. As OHA takes on the role of administering the navigator and independent assister program for the Exchange, it will be critical to have sufficient resources in place at OHA."

Finally, Veltri says "Our primary focus is always our consumers. The compassion and expertise of OHA’s staff and model of assistance is unique. We aim to honor our consumers by dedicating ourselves daily to successfully advocating for the treatment they need."

For free assistance, consumers can call 1-866-466-4446, or e-mail OHA at healthcare.advocate@ct.gov. For general information, Veltri recommends that consumers visit OHA at www.ct.gov/oha, on Facebook and on YouTube

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