When you need help

You might feel helpless if your HMO refuses to pay for an emergency room visit or the new drugs your doctor prescribed, but there are agencies that will assist you.

Some can give you detailed information about insurance policies, procedures and paperwork, while others will counsel you on the different insurance options available. Some can even go to bat for you when you're having trouble with your HMO.

Senior citizens can turn to SHINE, which stands for Servicing the Health Insurance Needs of Elders. This agency, set up and funded by the state's Executive Office of Elder Affairs, offers counseling and assistance to seniors concerned about health-care benefits.

For more information, call the SHINE's main number at (800) 882-2003 or the regional office in Danvers at (800) 598-1122.

If you feel you've been wrongly denied treatment or have had other problems with coverage, you can file a grievance directly with your HMO.

State law requires HMOs to have an appeals process. However, the law does not specify how quickly HMOs must act on complaints, which could leave you paying for expensive treatments out of pocket until the issue is resolved.

You can also turn to the hospital where you receive treatment. Hospitals often have customer relations departments that help patients sort through HMO policies, paperwork and questions.

However, there are usually limits to what the staff can do. If the patient didn't follow the rules and, for example, didn't get a referral to see a specialist, then the patient may have to resolve the problem on his own.

You can also ask your doctor to call the Massachusetts Medical Society at (617) 893-4610. The MMS is available to help doctors with claims and medical policy issues.

To get a copy of the MMS' pamphlet "What Do I Do When My Health Insurance Says No," call (617) 893-4610, Ext. 1393. The pamphlet lists the following agencies as other consumer resources:

Health Care for All, at (800) 272-4232 or (617) 350-6207, can help you with questions or problems you might have with your health plan. Leave a detailed message, including your name and phone number.

The Disability Law Center, at (617) 723-8455, specializes in assistance on matters concerning disability rights.

The Medicare Advocacy Project/Greater Boston Legal Services, at (800) 323-3205, provides free legal advice and/or representation to ensure Medicare beneficiaries obtain the Medicare and Medicare-related health insurance coverage to which they're entitled.

The Massachusetts Division of Insurance, at (617) 521-7777 or (617) 521-7794, provides information about health insurance plans and will consider complaints about claims, payment delays or denial of coverage.

The Office of the Attorney General, at (617) 727-2200, investigates complaints about health plans, such as denial of coverage.