If consumers lose their internal appeal with their health insurer, who refused to cover a medical procedure or pay for a medical service that they know was supposed to be covered, they can appeal to an outside agency. The Maryland Attorney General's Protection Division has a Health Education and Advocacy Unit. "We want to come in when one individual can't take on a huge insurance company. They usually give up, but what we're trying to say is don't give up," said Maryland Attorney General Doug Gansler. "A lot of people don't know about this free service, but if you need help, call our dedicated number at 410-528-1840."
The HEAU was established in 1986 as a resource to assist consumers with health care billing disputes. It's mission has since expanded to include identifying available health insurance options for Marylanders, as well as working with patients whose existing health plan has refused to cover a medical procedure or service. Through mediation, the Unit also helps consumers negotiate refunds for defective medical equipment.
In fiscal year 2012, the HEAU answered over 8,100 hotline calls, received over 2,000 complaints, closed over 1,700 cases and recovered or saved more than $1.7 million for Maryland consumers. Carriers modified or overturned 53% of the appeals and grievances cases the HEAU mediated and closed in 2011. Since it's formation in 1986, the Unit has recovered or saved consumers more than $18.9 million.