by Bea Peterson
Timothy Clune, Chief of the Health Care Bureau of the Office of NYS Attorney General Andrew Cuomo assured everyone attending the ROUSE (Rensselaer Organization United for Senior Endeavors) meeting at the Hoosick Falls Senior Center on Wednesday, May 20, that when they called his office there would be no “touch tone torture.”
“When you call our 800 number a person will answer your call,” he said. Clune, a Rensselaer County resident, has been working in the Attorney General’s office for two years. He describes the services the Health Care Bureau offers as “government at its best.” He told the group that whether their issue with an insurance company is large or small, they should contact the hot line. “If it is happening in Rensselaer County,” he said, “it could be happening in other counties.”
Clune gave an example of a problem that has been addressed by the Bureau. A patient goes “out of network” for a doctor. The usual and customary fee to visit that doctor, it is assumed, is perhaps $100. A patient assumes the insurance company will pay 80 percent or $80 and the patient will pay the remaining $20. Not necessarily so. The insurance company may say the usual and customary fee they pay that doctor is $20. Therefore they will pay $16, and the patient will have to pay $84. He said there is often a lack of transparency with insurance companies regarding rates. A web site has been set up so that patients can know what the usual and customary rate is for an insurance company and a doctor.
Clune said the Bureau also has a medicaid fraud control unit to deal with abuse in facilities that offer board and care.
He said New York State has contacts with federal medicare and medicaid agencies to resolve problems with them as well.
The brochure he handed out states his office will help claim benefits when an HMO denies coverage. They will assist with health care billing and payment problems and obtain individual guaranteed health benefits. If a person loses insurance coverage, they will investigate. “Businesses change bad behavior when they know they are being watched,” he said.
The Health Care Bureau is dedicated to making sure everyone knows his or her rights when receiving health benefits.
Numbers for the Bureau are 1-800-428-9071 or 518-474-8376. The fax number is 518-402-2163. For more information on the Attorney General’s Office visit http://www.oag.state.ny.us on the internet.