Consumer Assistance Programs: Making Sure Health Insurance Works for You

By Kathleen Sebelius, Secretary of Health and Human Services
Posted June 07, 2012

Recently, a woman in Maine was facing $34,000 in hospital bills for costs related to a mastectomy and reconstructive surgery that her insurance company was refusing to pay.  Thankfully, Maine’s Consumer Assistance Program identified a law that required the insurance company to pay part of those costs, and they helped her file an appeal that led to the insurance company covering an additional $24,000 of her medical expenses.

Health insurance problems are difficult enough to sort through in the midst of our busy lives, but they can be overwhelming when we or our loved ones are sick.

That’s why the Affordable Care Act includes resources to help states strengthen existing Consumer Assistance Programs or start new ones.  In this case, Maine used grant funds to increase its ability to file appeals on behalf of consumers and to educate consumers about the appeals process.

Today we’re releasing a report that shows the remarkable assistance that Consumer Assistance Programs have given to consumers over a one-year period.

From October 2010 to October 2011, Consumer Assistance Programs funded by grants authorized under the Affordable Care Act:

  • provided direct assistance to over 200,000 consumers
  • helped overturn insurance company decisions in favor of more than 22,000 consumers
  • obtained more than $18 million in direct savings on behalf of consumers and millions more due to more choices and better benefits
  • provided valuable outreach and education to hundreds of thousands more

Put simply – these programs work.

That’s why we’re also announcing today that we’re providing nearly $30 million in grants to existing or new Consumer Assistance Programs.

We want to make sure that these programs have the resources to continue the critical work they do. It’s work that literally saves lives. Beth, a mother in Massachusetts, found this out first hand when her 20 year old son, Joe, was diagnosed with Stage 4 Hodgkin’s Lymphoma.

Joe faced a course of extensive and aggressive treatments – so much that he would have to take medical leave from college and go home to his mother in Massachusetts. But because he had to leave school, Joe was no longer eligible for his student health insurance.  Beth couldn’t afford the premiums if Joe joined her plan. Joe suddenly found himself uninsured and in need of thousands of dollars’ worth of treatment—treatment that Beth couldn’t afford to pay out of pocket.

Fortunately, Beth called the Massachusetts Consumer Assistance Program.  Its staff worked with Beth and Joe to find affordable health insurance that met their needs, and helped Joe to enroll.

Beth says that, thanks to this program, Joe was able to receive treatment, and he’s responding well.

We can always use a helping hand in understanding our rights and protections as we find the best health coverage for ourselves, and for our families.  Thanks to the Consumer Assistance Program, that help is just a phone call away.