Denied coverage? Law aims at making patients aware of appeals options

Fortunately for Rep. Andrew Fleischmann, his wife had the foresight to buy the Lexus of health care plans.

But he soon discovered that meant little when he was diagnosed with cancer and later denied coverage at the hospital he chose for treatment.

“All the bureaucrats on the phone said this is not covered in your plan. I felt like I was left to figure out how to overcome this denial on my own,” the West Hartford Democrat said.

Now Flieschmann is on a mission to make sure insurance companies explain the options for appealing when they deny a claim.

A bill passed by the state House of Representatives this week requires insurance companies provide that information, including the phone number of the state’s Office of the Health Care Advocate. Last year, the office heard 2,600 denials and reversed some 85 percent of those.

“Too many people think their insurance company has the final say — that’s just not the case,” said Fleischmann. “No one should miss out on a covered benefit because they didn’t know how to appeal.”

But Keith Stover, lobbyist for the Connecticut Association of Health Care Plans, said the bill is “generating paperwork for the sake of generating paperwork without substantive change for the consumer. It’s just something else that they’re making insurance companies do.”

Patients who are denied coverage can appeal to the state Insurance Department. First, however, they must exhaust appeal options with their insurance carrier or establish that the claim is for a life-threatening condition. Last year the department handled 270 appeals, of which 66 were reversed and 7 revised.

Another option is to turn to the state health care advocate. But Fleischmann says too many people don’t know it exists.

“This will tell them, ‘If denied call this number and they will take care of your appeal,'” he said.

Advocate Kevin Lembo expects to see “huge increases” in the number of people calling his office asking for help if this bill becomes law.

“We have no idea of how many denials there are right now. Hopefully we are about to get a better sense,” he said.