Need help getting your insurer’s approval? There’s apparently a D.C. ombudsman for that

Need help getting your insurer’s approval? There’s apparently a D.C. ombudsman for that

Oct 13, 2014, 3:00pm EDT Updated: Oct 14, 2014, 7:59am EDT

D.C. Health Care ombudsman

D.C. has a health care ombudsman? Don’t feel bad if you didn’t know. The office is launching its first campaign to advertise its services this week.

Tina Reed

Staff Reporter- Washington Business Journal

Did you know D.C. has a “ health care ombudsman"?

If you didn’t, you’re not alone. For five years, the small office within the Department of Health Care Finance charged with helping residents and workers when insurers deny their claims has been operating under the radar.

With the onset of open enrollment for health plans, the Department of Health Care Finance started trying to change that for the first time. This week, the office began advertising its new ”Healthcare On Tap” campaign to any D.C. residents or workers having trouble with Medicaid, Medicare, their employer-based insurance and even the coverage they purchased on the District’s exchange, D.C. Health Link.

The profile-raising campaign includes a TV commercial showing residents contacting the small office with questions about problems with their insurance via decidedly low-tech tin cans attached to strings. It was funded in part through federal grants, including one for about $200,000 made available under the Affordable Care Act.

“People don’t appeal the decisions, the denials that insurance companies give them. They just accept them. They don’t know they can appeal,” said Health Care Ombudsman Maude Holt.

The office has about a dozen full-time people and four interns to help address calls for help from people who live or work in the District, Holt said. They pore over plans to see if individuals actually should receive coverage under their plans and try to persuade insurers to overturn their decisions — or work with the affected residents to change their policy should they learn they aren’t eligible for coverage, Holt said. The Department of Health Care Finance handled some 6,500 cases in fiscal year 2013. They say they were able to resolve 95 percent of those cases successfully, although the definition of success seems to vary widely.

Among one of their side roles, Holt said, is actually talking to businesses directly about the benefits they offer when they notice glaring gaps. An example, she said, many plans don’t cover the cost of wigs as prosthesis to women being treated for breast cancer. The office doesn’t have the authority to make the business change their coverage but can make recommendations regarding benefits that may ultimately help them.

“A healthy population is a more productive population,” Holt said.

Tina Reed covers health care.


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