Connecticut health agency fights desperation among the insured [Stateline.org]
|By Michael Ollove, Stateline.org|
|McClatchy-Tribune Information Services|
The last is a particularly valuable trait because Smith frequently finds herself on the opposite end of the telephone with someone at the edge of desperation, if not a good deal beyond it. It might be a mother distraught after her teenage son has been rushed to an emergency room following a suicide attempt and her insurance carrier balks at paying for his hospital admission. It might be an elderly man enraged over a
Smith, director of consumer relations at the
And Smith managed to calm the mother of the child with cerebral palsy. The insurance representative who claimed the carrier didn't pay for "durable medical equipment" didn't know what he was talking about, Smith reassured the woman. "That denial," Smith said, "had absolutely no foundation whatsoever."
Smith is the only employee at the
One of the typical functions of these programs is helping consumers navigate the marketplace of health insurance, whose unfamiliar language, fine print and riders confuse even sophisticated buyers. The programs help buyers through the arcana to find the insurance plans that best fit their needs and those of their families.
But it is the role of advocate that most endears consumer assistance programs to their clients, many of whom have waged lonely and unsuccessful fights over medical bills before discovering a knowledgeable and persistent ally.
"It's a very onerous process to appeal an insurance company denial," says
The problem, of course, is that when denials occur, consumers very quickly feel like adversaries rather than policyholders.
Veltri's office represents clients from the moment of an initial denial to the end of the appeals process. Among those on the 15-person staff are lawyers, like Veltri, and nurses, like Smith. It's a good deal more firepower than most consumers can bring to bear themselves.
"They were constantly in contact with my insurance company, my surgeon and the hospital and me," says
Back found her way to the Advocate's office thanks to a notice included in her denial letter from her insurance company.
In 2011, Veltri's office received 5,511 complaints on health insurance matters. The Advocate's work that year resulted in
Some health policy organizations prefer healthcare assistance programs that operate as part of state government and others prefer the non-profit model, as it exists in
Veltri rejects that notion. She insists that her office does have independence; it is not part of the
"I don't have any problem with non-profits doing this work, but being inside state government adds value to what we do, including access to data and access to other state agencies. And, from the consumers' point of view, there's nothing like the feeling of having a state agency being behind you."
As if to ram that point home, in the office down the hall,
Although he had not yet received a definitive answer, he wanted to end his conversation with Chamberlain on a hopeful note. "I will fight for this until I'm absolutely sure there's nothing left to fight for," he told her. "I live for this."
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