Maryland Attorney General: Report – Health Education Advocacy Unit Saves $2.8 Million for Patients, Maryland Consumers
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Annual Report Reveals a 76% Increase Over the Last Three Fiscal Years in Adverse Decisions by Insurance Carriers
The HEAU offers mediation services to consumers who have billing or other business-related disputes with their healthcare providers or coverage disputes with their health benefit plans. The Unit also helps consumers who have been denied enrollment in a Qualified Health Plan or denied Advanced Premium Tax Credits or Cost-Sharing Reductions by Maryland Health Connection,
"Health carriers that inappropriately deny claims cause emotional and financial burdens for Marylander consumers," said Attorney General Frosh. "We continue to see large numbers of adverse decisions that can sometimes deny a patient necessary, lifesaving treatment. As a result of the work of the HEAU, our office continues to see disputed cases achieve positive outcomes."
In one case mediated by the HEAU, a newborn--who was born seven weeks premature in a
In another case, a patient diagnosed with high-risk prostate cancer, with only a 30 percent survival rate when treated by surgery alone, petitioned his insurance to cover his participation in a clinical trial for new treatment. After the insurance company denied coverage for the trial, the HEAU intervened, provided the necessary evidence to favorably resolve the dispute, and coverage was approved the next day. The patient recently contacted the HEAU to announce that he is cancer-free, and his quality of life has been restored.
In FY 2018,
Of the 2,290 cases closed by the HEAU in FY 2018, 1,000 were appeals and grievances-related cases. Of those cases, 71% involved assisting consumers with mediating or filing grievances regarding claim denials by their health plans. The HEAU mediation process resulted in health plans overturning or modifying 49% of their denials, and resulted in health plans changing their decisions 58% of the time in cases involving at least one
Copies of previous year's reports can be found here (http://www.marylandattorneygeneral.gov/Pages/CPD/HEAU/annualreports.aspx).
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