WASHINGTON – Bernadette Warren was at wit’s end.
A friend had incurred almost $300,000 in medical bills grappling with a variety of life-threatening illnesses, only to have her insurance company deny coverage. And Warren, a former insurance company employee from Upper Marlboro, was getting nowhere in her efforts to get her friend’s insurance company to reconsider.
Until she was pointed to Dean Muscello, one of Maryland’s four health insurance ombudsmen.
Warren said Muscello acted as an intermediary with the insurance company, writing letters, making phone calls and explaining things for Warren and her gravely ill friend, who eventually had about $200,000 of her bills paid.
“I’m not a doctor or God but I know the experience with Mr. Dean Muscello and his unbelievable accomplishments in this case have been close to a miracle,” Warren told a Senate committee Wednesday.
“Without him, I truly believe that (my friend’s) situation would have been impossible to bear,” said Warren, who had to pause several times to choke back tears in her testimony to the Senate Health, Education, Labor and Pensions Committee.
Several states have healthcare ombudsmen like Maryland’s. Every state needs one, Warren told the committee, which was considering the Health Care Consumer Assistance Fund Act.
The act would budget $100 million for ombudsman’s offices in states that decided to set up such programs. States that set up ombudsman programs and paid at least 25 percent of the cost of operating them could apply for some of the federal funds under the act.
Programs would assist consumers with information, advice and referrals. They would not litigate, regulate or lobby. Supporters of the bill said states could use the Maryland model — a government agency set up by the legislature — or they could contract out to a non-governmental organization.
Maryland’s program was one of the first in the nation when it began in 1986 with one ombudsman and a volunteer staff, according to Cheryl Fish-Parcham, associate director of health policy for Families USA. Increased state funding allowed it to expand in 1999 to four ombudsman, who handle about 120 cases each at any given time.
Sen. Barbara Mikulski, D-Baltimore, said Wednesday that the office of ombudsman is important because it guarantees consumers will have someone on their side to explain the complicated system and act as an intermediary with the insurance companies.
Mikulski praised Warren’s testimony, which fellow panelist Charles Kahn III, president of the Health Insurance Association, called “very compelling.”
Warren was asked to testify by Families USA, a national, non-partisan organization promoting consumers’ health care rights. The organization asked state ombudsman programs for compelling witnesses, and Warren was recommended by Muscello.
Warren’s friend, Patricia Jean Bostwick, became gravely ill in 1998. A diabetic, Bostwick had both legs amputated and had a series of stokes, among other health problems. Her health provider refused to pay some of her bills, totaling almost $300,000.
Warren tried to use her experience as a former employee for Mutual of Omaha, to get Aetna to reconsider its decision, but it took the ombudsman’s office to help get some of Bostwick’s bills paid. She said Muscello’s help was “essential.”
“He succeeded where I couldn’t. They (the insurance company) wouldn’t even talk to me. I’m a nobody,” Warren said. “People take notice when they hear or see the words, Health Advocacy Unit, Maryland Attorney General’s Office.”
Warren said she hoped her testimony helps and she encouraged Congress to support the ombudsman bill “so others in every state will benefit as the Bostwick family and I have” with Muscello.
“He’s a god. He’s my angel,” Warren said of Muscello.