Fighting an Insurer? Call Cuomo’s Office
This article is from the archive of The New York Sun before the launch of its new website in 2022. The Sun has neither altered nor updated such articles but will seek to correct any errors, mis-categorizations or other problems introduced during transfer.

New Yorkers having trouble convincing insurance carriers to reimburse bills have a powerful ally in Albany: the state attorney general’s office.
With backgrounds ranging from health care advocacy to civil service, the six full-time patient advocates who work for Attorney General Andrew Cuomo are charged with navigating the labyrinthine health insurance industry on behalf of those who believe they were wrongfully denied coverage of medical treatments.
While Mr. Cuomo’s office declined to specify how many decisions it has helped to reverse, advocates handle hundreds of calls each month. The “vast majority” of them are resolved in favor of the policyholder, a spokesman for the attorney general, Jeffrey Lerner, said.
In large part, the program, established in 1997, offers New Yorkers an advocate who will “fight on their behalf,” Mr. Lerner said. Many times, advocates possess a certain sophistication required to read the insurance company’s fine print.
“Our health insurance system is complex, to say the least,” the director of the Center for Medical Consumers, Arthur Levin, said. In fact, some insurers bank on that complexity to turn people away, he said. “People give up, they get worn down,” Mr. Levin said.
Indeed, stories shared by individuals aided by the attorney general’s advocates illustrate what some see as the problem with the health insurance industry.
Last year, Frances Nocera, 51, spent three weeks at Staten Island University Hospital after she developed a severe infection following a tooth extraction. Despite needing four surgeries during her stay, Ms. Nocera’s insurer, Atlantis Health Plan, refused to pay the bill, telling her the condition was a dental episode, she said.
“It was a medical emergency,” Ms. Nocera told The New York Sun recently. When she appealed to Atlantis, “Everything was deny, deny, deny,” she said.
A senior vice president of Atlantis, Steve Denes, declined to comment on her case. “We approve appropriate utilizations and we have people here who make those judgments,” he said. With 17,000 policyholders within the five boroughs, “Atlantis is the lowest price community plan in New York City and the way we keep that is by not rubber stamping approvals,” he said.
Analysts praised the attorney general’s program for keeping the industry in check.
“It’s this really complicated system that the average person doesn’t care about until they have to interact with it,” a health policy analyst with the Manhattan Institute’s Empire Center for New York State Policy, Tarren Bragdon, said. Mr. Bragdon suggested the complexity of the system perhaps behooves the attorney general to do a better job of publicizing the program.
A 30-year-old of Queens, Peter Kefalas, said he contacted the attorney general’s office when he needed a $15,000 hernia operation that his insurance company refused to pay for. Each time he called the insurer, he spoke to an agent who would be “reading off a script, which was their rules and regulations,” Mr. Kefalas, who works in software sales, said. “It’s a bunch of legal jargon,” he said. “It’s a bad feeling, too, because you know that your policy is being paid and you know they’re supposed to be there.”
While Mr. Kefalas said his surgery cost $15,000, officials from Mr. Cuomo’s office said anecdotally that advocates handle everything from $100 to $200,000 claims. People seeking an advocate’s help are rarely turned away.
Most of the people interviewed for this article said they still subscribe to the health plans that gave them so much trouble.
Ms. Nocera, who suffers lingering health effects from the infection, said she has no alternative. “I’m afraid of just dropping it,” she said.