Billing woes, insurance denials: Hundreds of health care complaints filed in Rochester area
About 525 New Yorkers filed complaints last year involving suspected medical billing errors, health insurance denials and other health care abuses across the Finger Lakes, Hudson Valley, and other upstate communities, according to a top state investigative unit.
Of that total, nearly one in four cases were resolved with full relief provided to the New Yorker who filed the complaint with the state Attorney General’s Health Care Bureau, state data show.
Put differently, about 130 patients in Monroe, Westchester and seven other counties used the state agency to fight back against a health care system plagued by wrongful billing practices, unjust insurance coverage denials and other barriers to quality care.
The newly reported complaints data is part of USA TODAY Network’s ongoing investigation of New Yorkers struggles accessing and paying for health care.
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To improve public understanding of the helpline complaints, USA TODAY Network obtained exclusive 2023 complaints data for health care providers and insurers operating in the Rochester area.
Consumers there reported issues with hospitals, urgent cares and a range of medical fields, as well as local, regional and national health insurers, according to an analysis of the data released via a public records request.
The highest complaint totals involving the region included:
Excellus BlueCross BlueShield: 30 complaints (Empire BlueCross BlueShield had another five)
UR Medicine health system, including Strong Memorial and Highland hospitals: 20 complaints
Rochester Regional Health, including Rochester General and Unity hospitals: 11 complaints
A total of 26 complaints statewide involved ambulance providers, including Empress EMS, American Medical Response, Monroe Ambulance Transportation, Harrison Emergency Medical Services, St. John’s Ambulance Services and Mobile Life Support Services.
In addition to the 130 fully resolved complaints, other cases were closed for a variety of reasons, including self-resolved disputes.
Some complainants also did not reply to investigators. Other cases ended when the probe deemed no violation occurred or the complainant got further information from the health care entity or investigators.
USA TODAY Network is pursuing additional records related to the data to further explore details of the types of complaints filed and resolution.
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How to fight health care billing, insurance mistakes in NY
New Yorkers feeling wronged by the health system should contact the Attorney General’s Health Care Bureau Helpline, which secured a total of about $7.5 million in restitution and other savings from 2019 to 2022, the latest state data show.
There is an online complaint submission portal at ag.ny.gov, as well as the hotline at 1-800-771-7755. The most common complaints filed with the helpline involve billing errors, insurance coverage issues and prescription drug costs, though COVID-19 specific complaints also piled up in recent years, state records show.
The statewide total of helpline complaints filed last year, as well as the amount of restitution and savings secured, is expected to be released this summer.
Another key resource is the state Department of Financial Services, which offers advocates and experts to help New Yorkers navigate a range of health insurance issues.
That included fielding complaints from some of the thousands of New Yorkers who challenge health insurance denials each year. In 2022 alone, 10,400 insurance denials were reversed through the grievance process, the latest state data show.
This article originally appeared on Rockland/Westchester Journal News: Hundreds of health care complaints filed in Rochester NY. Here's why
