Kathleen G. Kane - Pennsylvania Office of Attorney General - Protecting Pennsylvanians

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Health Care Unit

In 2002, the Attorney General's Health Care Unit was created as a specialized division within the Bureau of Consumer Protection - dedicated to mediating health care related complaints on behalf of Pennsylvania consumers. Over 3,500 complaints have been handled by the Unit, resulting in savings to consumers of over $5 million.

The most common problems the Unit handles include billing disputes, denials of coverage and access to care issues. These problems can involve physicians or other professional health services providers; hospitals, clinics and other health care facilities; durable medical equipment providers; third party administrators; discount medical benefit plans; laboratories or health or long term care insurers.

The health care industry is complex and challenging and consumers need to be increasingly pro-active in making decisions related to their health care. Ask questions to be certain that you understand your benefits and the extent of your coverage. It is important to:

  1. Understand which health insurance policy pays first (or is the "primary" insurance), if you have coverage through more than one policy. That way your providers will be able to bill correctly for their services.
  2. Obtain and keep a copy of your summary of benefits handbook and any other materials you receive related to your health care insurance for information about your benefits and your appeal rights. These documents contain important information about your policy and explain coverage limits, exclusions or caps. These documents can be obtained from your employer, plan sponsor or insurer.
  3. Understand that you have a right to a copy of your medical records and your doctor has a right to charge a reasonable fee for the cost of copying and postage in order to obtain them.
  4. Keep a record of your medical bills and any "explanation of benefits" (EOBs) documents you receive from your insurer.
  5. Respond to medical bills you receive. Do not assume that your insurance company will pay for the service or that the claim has been filed. Contact the insurance company and the provider to determine if there is a problem and what should be done to resolve it. Keep a record of these conversations, including the date, who you talked to and what you were told.
  6. Verify that all providers and facilities you use for your health care needs are covered by your insurance plan. For instance, you should ask, prior to having surgery, if all providers (such as the surgeon, clinical facility and anesthesiologist) involved in the procedure are members of your insurance plan's network.

If you experience a problem with your health care that you are unable to resolve, contact the Office of Attorney General's Health Care Unit at 1-877-888-4877 between 10 AM and 3 PM or call 717-705-6938 between 8:30 AM and 5 PM.