Ohio DOI Recovered $5 Million in Health-Care Services

Ohio’s Patient Protection Act, which allows qualified consumers to appeal the denial, reduction or termination of health care services by their health carrier, has saved Ohioans nearly $5 million since May 2000 – including more than $1 million last year – Insurance Director Ann Womer Benjamin announced.

The annual Patient Protection Act report was delivered this week to Ohio General Assembly leadership and Governor Taft, who signed the Act into law on July 13, 1999 expanding protection for Ohio’s health care consumers.

“Ohioans can take advantage of this service at no personal cost if they feel they have been denied health insurance benefits and if they have exhausted their insurer’s internal appeal process,” Director Womer Benjamin said. “I encourage Ohioans to call the Department’s consumer hotline at 1-800-686-1526 or visit our web site at www.ohioinsurance.gov for assistance.”

In the 44 months since the program began, 1,889 cases have been conducted through external independent review organizations (IRO) and contract reviews. A total of $4,675,705 in previously denied insurance benefits has been recovered for Ohio health care consumers.

The Patient Protection Act provides consumers who have been previously denied coverage for a health insurance claim or have had coverage reduced or terminated the right to request an IRO to review the case. Under the statute, the review must be completed in 30 days, and expedited reviews involving serious health issues must be completed within seven days. External reviews are assigned to one of five randomly selected organizations accredited by the Department. In cases where the dispute involves contractual matters such as coverage limits or definitions of coverage, the Department conducts the review internally.

Decisions by the IRO in favor of the consumer are binding on the insurer, while consumers retain the right to file private lawsuits even if the IRO decision is not in their favor. Consumers do not bear the cost of an external or contractual review.

The Ohio Department of Insurance is committed to providing consumer protection through fair but vigilant regulation while promoting a competitive environment for insurers. The Department regulates and licenses approximately 1,800 insurance companies, nearly 166,000 agents, and more than 11,000 insurance agencies, and monitors the financial solvency of the insurance industry in Ohio.