Real problems with health care

What we do 

The Office of the New York State Attorney General’s Health Care Bureau is dedicated to making sure you know your rights and to helping you get the health benefits you are entitled to. 

Our office:

• Helps consumers navigate the complex health care system.
• Helps consumers challenge insurers that deny coverage.
• Targets health care organizations that have fraudulent, misleading or deceptive practices.
• Educates New Yorkers about their health care rights.
• Pushes for laws, regulations and policies that enhance the rights of health care consumers. 

The Health Care Bureau has successfully helped individual New Yorkers: 

• Receive cancer treatment that had been denied.
• Obtain a high cost specialty drug where preauthorization had been denied.
• Obtain a reversal of a health plan denial, resulting in payment of a $128,000 hospital bill.
• Reduce an improper balance bill from a provider for over $1000 to a zero balance.
• Obtain over $3000 in refunds after receiving wrong deductible determinations from insurer.
• Reinstate health coverage after uncovering billing errors.

Be informed

Health network coverage 

“In-network” providers agree to accept the insurance company’s payment, along with your co-pay as full payment. Check with your plan and all your providers — even labs — to confirm that those you want to use are in network. 

Check out-of-network coverage carefully. Plans may pay very little to out-of-network providers, leaving you to pay the balance. 

Prescription drugs 

Check whether your medication is on the plan’s list of covered drugs (“drug formulary”). If your plan requires you to use mail order and you believe you cannot, ask about a hardship waiver to use a retail pharmacy. 

Be proactive 

Question bills

You generally should not have to pay more than your deductible, co-pay, or coinsurance for any in-network provider. Compare any other charges to your coverage. 

Document everything

Write down the date of the conversation, the person with whom you spoke, and what was said. 

Appeal denials 

Exercise your internal and external appeal rights if your health plan denies a claim.

Request financial aid

Ask about a hospital’s financial aid program. If you are not eligible, ask whether the hospital will accept a discounted payment.

How does the helpline work?

Many consumers call the helpline because they do not fully understand their health insurance benefits, doctor or hospital charges, appeal rights, or where to get help. 

• Encounter a health care problem
  • Call Health Care Bureau Helpline (800) 428-9071 
• Initial assessment of complaint
  • Speak to advocate, mediation, reach a resolution
  • Receive information
  • Referred to appropriate agency