The Ombudsman Program provides education, guidance and general assistance to members concerning health insurance related issues. MSSNY staff is well versed in Medicare, Medicaid, Workers’ Compensation, Auto No-Fault, traditional indemnity and managed care programs. The Division maintains an effective liaison with third party health insurers, administrators, managed care entities and pertinent federal and state agencies on behalf of MSSNY members. Information and assistance is provided on medical reimbursement policies and claim processing requirements of various third party carrier operations, upon request. When or if the membership has a concern, it is common practice for clarification to be sought through the division. The majority (over 90%) of the contacts with the membership is via telephone communication involving points of clarification with any of the aforementioned plans.

 

The Ombudsman Program does not function as a collection agency. One purpose of the Program is to provide assistance to members of the Medical Society of the State of New York who perceive that they have reached a stalemate with a particular insurer or issue. 

 

After we have all pertinent data for the case in question, we communicate with the entity we believe will best service/resolve the issue as expeditiously as possible for all concerned parties.