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Advocacy for Patients With Chronic Illness, Inc. Releases Case Study

Posted on: Tuesday, 31 January 2006, 09:00 CST

Advocacy for Patients with Chronic Illness, Inc., a non-profit organization that provides free information, advice and advocacy services to patients with chronic diseases, today released a report on the practices of United Healthcare that are allegedly in violation of its own policies and the law.

The case study provides examples of three main areas in which, according to Advocacy for Patients' experience, United Healthcare has failed, while noting the report is not intended to be an indictment of this particular insurer, but rather of the health insurance industry itself.

Among the allegations is that United Healthcare routinely fails to comply with the "full and fair review" provisions of the Employee Income Retirement Security Act ("ERISA"), 29 U.S.C. section 1001 et seq., as well as its own policies and promises to its insureds. Specifically, United Healthcare fails to provide a copy of the file of the claim in a timely manner, and does not provide sufficient reasons for its denials of coverage.

Second, Advocacy for Patients alleges that United Healthcare routinely denies requests for coverage of an array of expensive procedures and treatments, only granting coverage after very burdensome appeals, even when the treatment sought is needed to treat a life-threatening condition.

Finally, United Healthcare has phased out coverage of ostomy supplies one state at a time, as they have purchased other insurers, bringing this coverage restriction on "disposables" to new markets on a regular basis. Advocacy for Patients is concerned that this marks a trend away from paying for ostomy and diabetes supplies and other disposables.

"We handle many health insurance appeals involving many health insurance companies, and there are moments of frustration in dealing with every insurer," Jennifer Jaff, founder of Advocacy for Patients, explained. "However, United Healthcare stands out."

Ms. Jaff adds that while her organization has faced obstacles with nearly every insurance company, United Healthcare is the only one she has seen violate ERISA provisions on a routine basis, even after many attempts to obtain compliance.

Richard Blumenthal, Attorney General for the State of Connecticut, said the case study confirms behavior that his office has routinely experienced.

"The Advocacy for Patients with Chronic Illness' report on United Healthcare mirrors my office's experience with many health insurers: patients suffering from debilitating diseases must fight through a bewildering process to obtain insurance coverage for critically important health services," Mr. Blumenthal said. "Patient advocates across the state must work together to ensure patients' rights to fair and adequate health insurance coverage.

"This report provides an important public service by exposing critical problems in the current managed care system. It demonstrates that reform is needed to relieve the burden on patients and to break down adversarial barriers that often develop between managed care companies and their participating physicians seeking necessary medical care for their patients. I am grateful to this significant group for its thoughtful and useful work," Mr. Blumenthal added.

Linda Aukett, Advocacy Chair for United Ostomy Associations of America, agreed with Mr. Blumenthal, stating that many health insurers seem unaware of their own policies.

"The experience of Advocacy for Patients with Chronic Illness with regard to United Healthcare parallels that of United Ostomy Associations of America in many ways. We have had correspondence go unanswered, have seen capricious application of their policies among our members, have been advised of a waiver about which we found their own sales staff were unaware," said Ms. Aukett.

"We are most appreciative of the efforts of Advocacy for Patients with Chronic Illness in preparing this thoughtful and constructive report," she continued.

To obtain a copy of the full report, please contact Jennifer Jaff at patient_advocate@sbcglobal.net or visit www.advocacyforpatients.org.

ABOUT ADVOCACY FOR PATIENTS WITH CHRONIC ILLNESS, INC.

Advocacy for Patients with Chronic Illness, Inc. is a tax-exempt 501(c)(3) public charity. We provide free information, advice and advocacy services to patients with chronic diseases in areas such as health insurance, disability insurance, Social Security disability, employment discrimination, family and medical leave, and educational equity.

Jennifer C. Jaff, Esq., author of the report, is an attorney licensed to practice law in the States of New York, Connecticut and the District of Columbia. Before founding Advocacy for Patients, she was an Assistant Attorney General in Connecticut, and a partner at law firms in the District of Columbia and Connecticut.

Source: Business Wire

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