Your Health Care Rights

(New London-WTNH, Dec. 17, 2004 5:50 PM)



Are you in the middle of a dispute with your health insurance company?



It can be frustrating making all those calls that seem to go nowhere.



Finding out what your rights are under managed health care in our state can be only one phone call away.



Hairdresser Susan Ramos needed to keep her 17-year-ol daughter in rehab treatment.



"There wasn't a stone I didn't leave unturned," says Susan.



But her health insurance denied her claim.



"We had that service entitled to us and we were being denied."



Susan was finally directed to the State's Office of Managed Care ombudsman where her daughter's issue was resolved.



Maureen Smith, Office of Managed Care ombudsman, says,"I made the call and said this is an issue. It needs to be resolved in a very timely manner and within a half hour I had a call from their senior medical director."



Kevin Lembo says,"Our primary role is to educate folks about their insurance coverage to help them understand their different plan designs and what those really mean for them when they show up at their doctor's office."



Newly sworn in state ombudsman Kevin Lembo says his staff of three fields an average of 2,500 calls a year from families like Susan Ramos.



Another responsibility this office tackles is assisting patients who are denied treatment through an appeals process in place.



"I don't come into this office assuming that the health insurance companies are wrong in their determinations but I do come to this office assuming that when a doctor says you need treatment you need it."



For Susan Ramos an independent advocate was all she needed.



"I knew that each state had its own ombudsman but I didn't realize that as far as health care issues that we had one strictly for health care."



If you have a problem or concern about your managed care plan you can call the office of managed care ombudsman at this toll free number 866-460-4446.