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The HLA Docket

The Quarterly E-newsletter of Health Law Advocates: Spring 2015
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A Message from the Executive Director

 

March 2015  

   

Dear Friends,

 

This year marks the 20th anniversary of HLA's beginnings. It was 1995 when HLA's partner organization Health Care For All launched its Legal Network program to provide legal advocacy for Massachusetts consumers denied access to health care. HCFA's Legal Network morphed into HLA the following year and the rest is (our) history. We've broken down countless barriers to health care for our clients over the years, but new challenges arise every day. Our team is as energized as ever to start the next 20 years of Fighting for Health Care Justice.  

 

Later this year, we'll hold our 20th Annual Benefit Breakfast where we'll celebrate our history and look ahead to our future advocacy. You'll receive information about this special event in the months ahead. The HLA Benefit Breakfast has included a lot of laughs, tears, fellowship and inspiration over the years and we're already preparing to make this year's event the best yet. I hope you will join us.  

 

In the meantime, I thank you for all you have done and given to help HLA get this far. Your support has put health care within reach for the most vulnerable in Massachusetts.    

  

Best regards,

 

Matt Selig
JHMAP

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A Six-year-old Girl's Dental Procedure 
Leads to a $15,000 Bill

A client profile 
 
   Six year old Haley Washburn flashes her golden smile 
Haley is a six-year-old girl with a rare genetic condition that led to rapid deterioration of her teeth due to a defect with the enamel. To save her teeth, Haley needed several extractions and crowns placed on the remainder of her teeth. The procedure, which one doctor called "full mouth rehabilitation," had to be performed in an operating room with Haley under general anesthesia because the dental work was so extensive. Haley's mom sought prior approval of the medical care, as well as cost estimates, from her daughter's health and dental insurers. After receiving approval, Haley had the procedure in February, 2014.

 

The results of the procedure were medically successful, but Haley and her mom experienced sticker shock when they received bills. Very large bills. The hospital charged more than $15,000 for "O.R. Services" and anesthesia, for which the health insurance company had denied coverage. Additionally, they received a bill from the dentist for more than $800, which the dental insurer denied after indicating in its pre-treatment cost estimate this amount would be covered.

 

HLA Attorney Andrew P. Cohen, along with Senior Staff Attorney Clare D. McGorrian, assisted Haley's mom to successfully appeal the claims denials to both the dental and health insurance companies. The health insurer approved the appeal, providing a network discount of more than $12,000 and payment of about $2,300 for the services, which left our client with an out-of-pocket responsibility of $585. Likewise, the dental insurer approved the appeal, leaving Haley's mom with $160 in out-of-pocket costs. Haley's mom was very pleased with the outcome and the family was able to pay the remaining balances over several months.  
Breakfast

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Commercial Insurance Appeals Program
Project Update

Since HLA's inception 20 years ago, we have been the only organization
Clare McGorrian, HLA Senior Staff Attorney and Director, Commercial Insurance Appeals Program 
providing pro bono legal services to low-income Massachusetts residents needing help securing coverage for health services by commercial insurers and self-insured employer health plans. This is a critical service because most Massachusetts residents ( more than 5 million) are enrolled in such plans.

 

A recent case involved K.A., an 18-year-old covered under her father's employer's health plan administered through a national health insurance company. K.A. needed jaw surgery as part of a three-year course of treatment to correct breathing, eating and speaking issues caused by a severe overbite. When the health plan denied coverage for the surgery, HLA helped K.A. and her providers work with the health plan to obtain coverage for the $62,000 surgery.

 

Earlier this year, HLA commenced our fifth round of federal funding in partnership with Health Care For All supporting our advocacy on behalf of consumers with commercial and self-insured health plans. One of the many positive features of the Affordable Care Act is that it authorizes federal grants to states for consumer assistance, including legal representation, for consumers in health plan appeals so they can attain full access to benefits under health care reform. The Massachusetts Executive Office of Health and Human Services and the Health Connector have each received such federal grants since 2010 and contracted with HLA and HCFA to provide consumer assistance.

 

From October 2010 to today, HLA's Commercial Insurance Appeals Program has assisted more than 1,000 consumers, including 304 in 2014, obtain health care access through commercial health plans. HLA's Senior Staff Attorney Clare McGorrian directs the Program while HLA's Nancy Ryan is the Program's full-time Staff Attorney. HLA's Mental Health and Addiction Parity Initiative Director Laura Goodman also contributes to the Program in cases involving commercial insurance coverage of behavioral health services. This team of leading advocates use their unique expertise to provide a range of valuable services to their clients, from advice and consultations on coverage issues to full representation in formal appeals procedures. They also frequently contribute their perspectives in policy discussions and as sought-after public speakers. 
Amy

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Board Profile: Brian Carey, Esq.
 
"There are few things in my legal profession that give me as much pride as the work that HLA staff carry out every day."  
HLA Board Member Brian Carey's experience at the center of the action in health care reform dates back more than 20 years. Fresh out of college, with a degree from the Wharton School of Business at the University of Pennsylvania, Brian moved to Washington, D.C. in 1992 to join Senator Edward M. Kennedy's staff on the Committee on Labor and Human Resources (currently referred to as the HELP Committee). As a staffperson for the Committee, which Sen. Kennedy chaired and had broad jurisdiction over health care legislation, Brian worked on health care, food/drug and biotechnology legislation.

In particular, Brian worked with HLA Executive Director Matt Selig (also a staffperson for Sen. Kennedy at the time) and for Nick Littlefield, the Committee's Chief Counsel/Staff Director, who was instrumental in the Senator's quest to secure affordable health coverage for all Americans. While ultimately unsuccessfully in enacting health care reform, during this period the Committee passed the Health Security Act as part of the national health care reform initiative led by President and First Lady Hillary Clinton. "Matt and I were privileged to work on Senator Kennedy's staff where we learned about health care justice, and to have mentors like Nick Littlefield and Mark Childress who taught us the role of the lawyer as an advocate for others," remarked Brian. 


Brian left D.C. for B.C., and graduated magna cum laude from Boston College Law School where he was also an editor for the B.C. Law Review. Brian then took his talents to the chambers and courtroom of U.S. District Judge Edward F. Harrington, where he served as a judicial law clerk, followed by a tenure as an associate at Sullivan & Cromwell in New York.

 

Ultimately, Brian returned to the Boston-area and joined the law firm of Foley Hoag, LLP to work again with Nick Littlefield. As an associate , Brian worked with Nick to build a health care policy practice. Now as a partner, Brian's practice focuses on federal legislative and regulatory issues impacting the life sciences and health care sectors. He also counsels clients on implementation of the Affordable Care Act and delivery and payment reforms. "There are few things in my legal profession that give me as much pride as the work that HLA staff carry out every day to fight for individuals and families to get the health care they are entitled to. I am happy to play a small part in helping to fulfill the HLA mission," noted Brian. 
  
Brian joined the HLA Board in 2009 and now serves as HLA's Treasurer. Health care advocacy runs in Brian's bloodlines and he knows as well as anybody the importance of organizations like HLA. His father, Bernard Carey, has served since 1975 as the Executive Director of the Massachusetts Association for Mental Health, a frequent collaborating organization with HLA. Brian uses his extensive experience on national health care policy issues to help guide HLA's strategies to improve consumers' access to care. He also plays an important role organizing and raising funds for HLA's beloved Annual Benefit Breakfast.
Parity

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OBAMACARE YIELDS NEW PROTECTIONS FOR PATIENTS WITH MEDICAL DEBT
     
NEW BILLING RULES FOR NON-PROFIT HOSPITALS

Not only has the Affordable Care Act helped more than 16 million Americans gain health insurance coverage, but its numerous other achievements include protecting hospital patients nationwide from uncovered hospital bills. On December 31, 2014, the IRS issued new rules implementing a section of the ACA granting important financial protections to patients in non-profit hospitals. These rules were eagerly awaited by HLA and advocates for health care access and affordability. HLA assists many clients with uncovered hospital bills that will benefit from these new safeguards.

The new federal protections against uncovered hospital bills fall into three categories: hospital financial assistance policies (FAP), limits on charges, and billing and collection practices. Every non-profit hospital must now have a written financial assistance policy that specifies all financial assistance available under the FAP, including discounts and free care, and the eligibility criteria for receiving such assistance. Non-profit hospitals must also limit ch arges for FAP-eligible patients to the amount generally billed to patients with insurance (i.e. the amount allowed by insurers instead of the gross charge). Finally, non-profit hospitals may not engage in extraordinary collection actions against a patient before making reasonable efforts to determine if the patient is eligible for assistance under the hospital's FAP. Extraordinary collection actions are things like reporting debt to a credit reporting agency, suing the patient, or selling the debt. HLA looks forward to partnering with Massachusetts non-profit hospitals to ensure compliance with these protections.   
Staff

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HLA Staff News
 
Please join us in welcoming the following addition to our fantastic staff:
  • Emily Tabor joined HLA as our new Program and Development Associate this month. Emily's responsibilities include fundraising, outreach and managing HLA's Pro Bono Legal Network. She previously was the Development and Communications Coordinator at First Literacy and the Development Coordinator with St. Stephen's Youth Programs. Emily is a graduate of Wheaton College. We are thrilled she is joining the HLA team!
To view a full list of HLA's staff and their bios please  click here.   
 

We also bid a bittersweet farewell to:

  • Samantha Roy who ended her tenure as our Program and Development Associate in February. Samantha made outstanding contributions to HLA, particularly as lead organizer of HLA's 19th Annual Benefit Breakfast.
Thank you for the fabulous work you've done at HLA. We wish you all the best in your future endeavors!
MHC

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YOU'RE INVITED!
MA Health Council
5th Annual Women's Health Forum

Register Here

When:
Thursday, April 16, 2015
7:30 am - 3:00 pm

Where:
Westin Copley Place
Essex Ballroom
10 Huntington Avenue
Boston, MA

Contact:
Betty Segal
Phone: 617 965 3711

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