HEAU Saves Patients Over $3M

Maryland Attorney General Anthony Brown announced that the Health Education and Advocacy Unit (HEAU) within the Consumer Protection Division closed 2,037 cases in Fiscal Year 2023, helping patients save or recover over $3.3 million dollars, including more than $2.6 million in appeals and grievances cases. The information was included as a part of the comprehensive Annual Report on the Health Insurance Carrier Appeals and Grievances Process submitted to the General Assembly.

The report notes, “Adverse decisions involving mental health/substance abuse services continue to be overturned or modified infrequently. In FY 2023, carriers reported an overturned or modified rate of 37% for mental health and substance abuse services.”  It also includes a vignette involving network adequacy, “The HEAU has handled ongoing mental health access issues for a family with a 16- year-old autistic son. The carrier has no in-network providers available to provide the child with all necessary services and was unwilling to approve telehealth services. Instead of providing the needed care, the insurer attempted to reduce needed services. The insurer also initially denied a single case agreement (SCA) with an out-of-network provider without considering the child’s unique needs. After HEAU intervention, the insurer entered an SCA with an out-of-network provider (for six months) and restored telehealth services. Although this arrangement is providing needed care, the insurer has not yet agreed to a longer-term means of meeting the child’s needs.”