Protection from Fraud under the Patient Protection and Affordable Care Act

The short answer: there is none.

The longer answer:  

The NYS Department of Financial Services, any health insurance consumer’s logical first stop for answers about Health Insurance Fraud, had a longer than expected hold time (16 minutes).  There was nobody available at their fraud office today, they took my contact information and promised me an eventual call back.  They also have an online complaint form that you can fill out and, presumably, print, fold and insert into a body part exempt from your health insurance coverage.  

The kind woman I spoke to there, Norma, did not know of any place except the U.S Department of Health and Human Services that possibly oversees any aspect of the Patient Protection and Affordable Care Act.  Twenty-nine minutes after I’d placed the call  to her I was dialing 877-696-6775.

There was no wait at the federal agency, though also no option to speak to a human.  The voice prompts were limited, it seemed the best bet was being connected to my state Department of Health and Human Services.   I tapped in the requested information and was connected to the New York State agency.    

Unfortunately, it was the New York State agency that handles temporary or disability assistance.  I could press various numbers to get information about child support and other programs, but none related to health insurance.  

I eventually tried the administrative office options and spoke to a sympathetic woman at the office of legal affairs.  While her sympathy was solid, she did not have unlimited patience or time, and after five or ten minutes commiserating she connected me, without further ado, to the Fraud Hotline.  This number is 877-873-7283.

Sadly for me, it was the Medicaid Fraud Hotline, and as my program is not administered by Medicaid, I had to make a human appeal to an even more sympathetic woman, who, after twenty minutes or so, worked with her supervisors during a short twelve-minute hold, and was able to  give me two more promising, and seemingly self-evidently logical, numbers to call.  

One is the NYS Department of Health, Office of Health Insurance, apparently an unlisted secret number: 800-343-9000.  I surmise that it’s an unlisted help line because it took several long calls, ninety minutes of sleuth work today alone, and almost cat-like patience on my part, to have a supervisor at the Medicaid Fraud office think of searching for this particular number.  

She told me the number used to be on-line but they removed it from the website, presumably too much traffic on that line, too many strangled, inarticulate cries for help, too much rage and despair for New York State’s limited allotment of representatives to handle.

The other number is the New York State Insurance Department, which, while seemingly a logical number to give to someone with a complaint about insurance in New York State, is apparently equally obscure.  This office can, hopefully, be reached at 800-342-3736.

I don’t know why, but barely two hours into the calls now, I suddenly ran out of steam to tell my story to another person who agrees that there ought to be an ombudsperson or help-line to oversee problems with a federal health law administered by the states, particularly one that consumers are mandated to buy on pain of a tax penalty for refusing to participate in.  

Even though health insurance and pharmaceutical companies wrote the PPACA, and their liberal one-sided exemptions therefrom, even as the despicably corrupt right wing Democrat Max Baucus (recipient of millions in contributions from those lobbies — the fucking scion is now Ambassador to China– a little ‘thank you’ from smiling Obama) oversaw the process, even as health insurance/pharma industry lifer Liz Fowler wrote the law, you would think there’d be some oversight involved somewhere.  

You would apparently be wrong to think that.  Nowhere in the 2,700 pages is there any provision for a mechanism to protect patients from fraudulent denial of services under their one-sided contracts with the private corporations.

The last well-meaning woman I spoke to suggested I call Empire Blue Crucifix and talk to their internal complaint department about my accusations of fraud against them.  She assured me there had to be a number on the back of my insurance card for complaints.  I checked.  There was not.  I read her the options.  “Customer Service!” she announced hopefully.  I gently dashed her hopes.

Maybe I am thinking about the condolence call we are going to be making in less than an hour for Sekhnet’s old friend whose mother died the other day and I want to clear my head.  Or something like that.  I certainly do want to clear my head, I can tell you for sure.

And the minute the talented Mr. Obama is a former president, make like Robert De Niro wanted to do with Trump, which he can’t do now, obviously, because of Secret Service Agents and the private security contractor army that surround the new most powerful and important man in the world.

Leave a comment