Health Care Concerns Identified In State Report
Attorney General Spitzer today released a report that identifies common managed care problems New Yorkers are experiencing and proposed new consumer protections to improve access to health care.
The report is based on a review of more than 10,000 consumer calls and complaints received over the last year-and-a-half by the Managed Care Consumer Assistance Program (MCCAP), the statewide education and direct assistance service for HMO and other health plan members in New York State. MCCAP is administered by Spitzer's Health Care Bureau and is funded by the New York State Legislature.
"MCCAP has helped thousands of New Yorkers navigate the twists and turns of the health care system and access quality care," said Spitzer. "We must continue working to ensure that New Yorkers are aware of their existing rights and protections, and are informed about how to file an appeal when denied payment for treatment or service."
Assemblyman Alexander "Pete" Grannis, Chair of the Assembly Insurance Committee said:
"MCCAP was established to respond to rising enrollment in HMOs and a corresponding increase in consumer complaints about not being able to access care. MCCAP is doing exactly what we hoped it would do. It's out there on the front lines across the state providing consumers with advice about how to maximize their care and helping them appeal denials by their HMOs and other health plans."
According to the report, among the most significant complaints shared by health plan members are:
- Limits placed on access to prescription drug coverage;
- Refusal to cover referrals to out-of-network specialists;
- Lack of clear reasons and rationales for coverage denials; and
- Insufficient knowledge of individual plan details and consumer appeal procedures.
"Staff and volunteers are now available through a toll-free hotline to respond to the needs of health care consumers in every county in New York State," said Spitzer. "I encourage all New Yorkers with managed care questions or complaints to call their local MCCAP organization or my Health Care Bureau's Health Care Hotline."
"It's important to be a savvy consumer so that you get the care you need." said Kristin Fiacco, of the Public Policy and Education Fund (PPEF) in Binghamton, a MCCAP organization serving Central New York, "We believe that all managed care enrollees need more information about how their plan works, and more information about their rights as consumers."
An executive summary of the report, along with its recommendations is attached. The entire report may be may be accessed on the Attorney General's Web site at www.ag.ny.gov or by contacting the Health Care Bureau at: (212) 416-8828.
Consumers needing assistance and information about their health insurance plan may contact the following managed care hotlines:
Attorney General's Health Care Bureau. Telephone No. (800) 771-7755
Attorney General Spitzer's Office operates a toll-free hotline providing information to New Yorkers on their rights and assists individuals in accessing benefits under their health insurance coverage.
Medicare Rights Center (MRC). Telephone No. (800) 333-4114
MRC operates a toll-free hotline specializing in information pertaining to seniors and people with disabilities.
NEW YORK CITY
Consumers living in the City of New York may access local assistance by contacting:
New York City Managed Care Consumer Assistance Program (NYC MCCAP). Telephone No. (212) 614-5500
OUTSIDE NEW YORK CITY
Consumers living outside the five boroughs of New York City may access assistance by contacting:
Legal Aid Society. Telephone No. (888) 500-2455
CENTRAL NEW YORK
Consumers living in Central New York including: Broome, Oneida, Onondaga, and Tioga counties may access local assistance by contacting:
Public Policy and Education Fund of New York. Telephone No. 877-706-2227
Consumers living in Nassau and Suffolk counties may access local assistance by contacting:
Research Education Project of Long Island. Telephone No. (516) 616-3345
WESTERN NEW YORK
Consumers living in Western New York including Allegany, Cattaraugus, Chautauqua, Chemung, Erie, Genessee, Livingston, Monroe, Niagara, Ontario, Orleans, Seneca, Schuyler, Steuben, Tioga, Tompkins, Wayne, Wyoming, and Yates may access local assistance by contacting:
Monroe County Legal Assistance Corporation. Telephone No. (585) 285-5670.
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