OHA: Office of Healthcare Advocate Saves $11 million for Consumers in 2016
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Office of Healthcare Advocate Saves $11 million for Consumers in 2016

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For Immediate Release                                                                                           Contact: 860-331-2441

March 30, 2017                                                                                                         


Office of the Healthcare Advocate Saves 

$11 Million for Healthcare Consumers in 2016

Savings Since Inception Now Over $81 Million


Connecticut healthcare consumers have reached a new annual high of $11.2 million in savings during calendar year (CY) 2016, according to Ted Doolittle, State Healthcare Advocate, pushing the office’s recoveries total since it began operations in 2001 to a remarkable $81.8 million. The Office of Healthcare Advocate (OHA) is an independent state agency that assists consumers with health plan education, billing disputes, eligibility issues and appeals of health insurance denials.


“This Report reflects that our team of nurses, consumer information representatives, support staff, and attorneys spent 2016 delivering the kind of free, prompt, responsive service that Connecticut families deserve,” said Doolittle. “I would like to publicly thank each member of the OHA team for the high volume and high quality of their work for Connecticut families last year.”


OHA directly intervenes and represents consumers with health plans, providers and agencies on denials of coverage for medical necessity, experimental/investigational status, and non medical necessity issues such as eligibility disputes, unwarranted billing actions, coding errors and non-covered services determinations.  OHA works exclusively on health issues, and its consumer recovery total reflects savings from intervention with all types of health plans. 


The substantial $11,168,483 savings total represents the costs of healthcare services, procedures, claims and coverage that would have been borne directly out of pocket by consumers, had the agency not intervened.  Among the types of consumer savings included in the multi-million dollar total for CY 2016 are:  savings and recoveries representing OHA’s successful appeals of complex medical and behavioral health treatment denials of medically necessary care, eligibility of coverage disputes, advanced premium tax credit savings and resolution of billing disputes.


Through its work with Department of Children and Families (DCF) on its Voluntary Services program, OHA directly saved or assisted that agency in avoiding an additional $2.99 million in taxpayer costs while ensuring coverage for families under their private health plans.  OHA assists DCF in determining which of its clients may have commercial health insurance, and then the team seeks payment or recoupment from the commercial carriers for services that DCF would otherwise have paid for itself.  These savings are representative of this unique collaboration that has been successful in educating state agencies, providers and consumers. OHA continues its collaboration with the Department of Developmental Services (DDS) on a similar project that helps families utilize their private health coverage for children who have autism related disorders.


OHA also conducted many outreach and education events in CY 2016 and continued its work on the Behavioral Health Clearinghouse established under PA 14-115 which connects consumers with available services around the state.


Looking forward, OHA has already started to deliver the same great casework results for 2017 as were achieved last year. But 2017 will also bring another new challenge, in that the office will be called on to respond quickly and accurately in advising policymakers in Hartford and Washington, D.C. in this historic time for healthcare policy,” Doolittle said.  “Contemplated changes at the federal level are developing rapidly. It is causing confusion and lots of concern. We want consumers, providers, businesses, state agencies and legislators to know they can turn to OHA for trusted, real time advocacy and expertise.”


OHA will continue to play a key role in outreach, education and advocacy for new enrollees in healthcare coverage in addition to the office’s continuing role in advocating for consumers in medical necessity and billing disputes and on systemic healthcare issues in Connecticut.


According to Doolittle, feedback survey results consistently praise the OHA staff for the expert and timely advocacy they provide.  Consumer evaluations conclude that 92% of people who come to OHA would refer a family or friend to OHA for help.


Consumers who need assistance can call 1-866-466-4446, or e-mail OHA at healthcare.advocate@ct.gov


For general information, Doolittle recommends that consumers visit OHA at www.ct.gov/oha,

at https://www.facebook.com/pages/State-of-Connecticut-Office-of-the-Healthcare-Advocate/301102456997?ref=hl and on YouTube at http://www.youtube.com/user/stateofctoha and Twitter @State_of_CT_OHA.





Content Last Modified on 3/30/2017 11:21:34 AM