Advocacy for Patients with Chronic Illness, Inc. Releases Case Study Detailing United Healthcare's Failure to Comply with Law; Alleges Insurer ''Stands Out'' with Violations of ERISA, Internal Policies.HARTFORD, Conn. -- Advocacy for Patients with Chronic Illness, Inc., a non-profit organization A non-profit organization (abbreviated "NPO", also "non-profit" or "not-for-profit") is a legally constituted organization whose primary objective is to support or to actively engage in activities of public or private interest without any commercial or monetary profit purposes. 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 according to prep. 1. As stated or indicated by; on the authority of: according to historians. 2. In keeping with: according to instructions. 3. 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 See Employee Retirement Income Security Act. ERISA See Employee Retirement Income Security Act (ERISA). "), 29 U.S.C. section 1001 et seq et seq. (et seek) n. abbreviation for the Latin phrase et sequentes meaning "and the following." It is commonly used by lawyers to include numbered lists, pages or sections after the first number is stated, as in "the rules of the road are found in Vehicle Code ., 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 ostomy Surgical opening in the body, or the operation creating it, usually to allow discharge of wastes through the abdominal wall. It may be temporary, to relieve strain on damaged organs, or permanent, to replace normal channels congenitally missing or surgically removed 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 Richard Blumenthal is the 23rd elected Attorney General of Connecticut. Education Blumenthal graduated with honors from Harvard College (Phi Beta Kappa; Magna Cum Laude) and Yale Law School, where he was Editor-in-Chief of the Yale Law Journal. , 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 de·bil·i·tat·ing adj. Causing a loss of strength or energy. Debilitating Weakening, or reducing the strength of. Mentioned in: Stress Reduction diseases must fight through a bewildering be·wil·der tr.v. be·wil·dered, be·wil·der·ing, be·wil·ders 1. To confuse or befuddle, especially with numerous conflicting situations, objects, or statements. See Synonyms at puzzle. 2. process to obtain insurance coverage for critically important health services health services Managed care The benefits covered under a health contract ," Mr. Blumenthal said. "Patient advocates across the state must work together to ensure patients' rights The legal interests of persons who submit to medical treatment. For many years, common medical practice meant that physicians made decisions for their patients. This paternalistic view has gradually been supplanted by one promoting patient autonomy, whereby patients and 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 New York, state, United States New York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of , Connecticut and the District of Columbia District of Columbia, federal district (2000 pop. 572,059, a 5.7% decrease in population since the 1990 census), 69 sq mi (179 sq km), on the east bank of the Potomac River, coextensive with the city of Washington, D.C. (the capital of the United States). . 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. |
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