Mission Statement - The mission of the Ombudsman’s Office is to ensure the safety and well-being of District consumers’ health care services through advocacy, education and community outreach.

The Health Care Ombudsman Program

The Health Care Ombudsman Program was established by the Council of the District of Columbia to provide assistance to uninsured District of Columbia consumers and individuals insured by health benefits plans in the District of Columbia regarding matters pertaining to their health care coverage.

What is an Ombudsman?

• An individual who investigates complaints by District consumers regarding health care issues against their health plan or provider.
• A neutral mediator in dispute resolution, with the ability to investigate and make recommendations – without authority to make or reverse a decision.
• An individual who will conduct their work objectively and without influence from representatives and Administrators of the DC Government.

Hot Issues Being Addressed

• Home Health;
• Eligibility;
• Alliance prescriptions;
• Coordination with Medicare Part D;
• Homeless residents with health issues;
• Coordination with Department of Mental Health for services;
• COBRA;
• Benefit denials;
• Non-payment of medical bills;
• Durable Medical Equipment;
• Coordination of early intervention services;
• Case manager changes/lack of managers;
• Not identifying children with special needs;
• Eligibility/provider continuity;
• Understanding of Medicaid benefits;
• Dental services for children; and
• Long time for approval of authorizations.

Contact Information
Office of Health Care Ombudsman and Bill of Rights
Department of Health Care Finance
825 North Capitol Street, NE, 6th Floor
Washington, DC 20002 (202) 724-7491
Office: (202) 478-1397
Fax: 1 (877) 685-6391 (Toll Free Number)