Depending on the type of health care coverage you have, there are different ways to lodge a complaint against an insurance company. A good starting point for determining your next step, is to find out if your health benefit is regulated by the Employee Retirement Income Security Act (ERISA). ERISA regulations only cover plans provided by private employers; therefore, non-private employer plans are not covered under ERISA regulations.
Non-private plans are provided by:
• State or Federal Government Agencies • Medicare • Medicaid • Public Schools • Workers’ Compensation • Military • Churches • Individual health plans for people who are self-employed or are not employed by a private employer
Patients whose health plan is subject to ERISA have certain rights. If you have a health plan governed by ERISA and you have been notified that a claim has been denied, according to the Department of Labor, the plan administrator must tell you how to submit the denied claim for a full and fair review. You have at least 60 days to request a review.
If Your Plan is Not Covered by ERISA, Contact Your Department of Insurance
State Departments of Insurance (DOIs) are obligated to investigate complaints reported by consumers. You can access the Ohio Department of Insurance here to report concerns with insurers. Some examples of appropriate times to report concerns to Departments of Insurance include; delays in payment, conflicts between described benefits and benefits rendered, and communication problems with insurers. If you have any concerns with an insurance company, report those concerns to your local DOI.
Give Us Your Feedback—Chiropractic Networks Management Companies Used by Insurers
There is a growing concern in the chiropractic community regarding insurers’ use of third party administrators and provider networks. These networks have been requiring chiropractic patients to complete burdensome paperwork, inappropriately denying benefits and limiting patient access to medically necessary care. If you think your insurer is using one of these networks, and you would like to share your thoughts on this issue, please email: insinfo@acatoday.org.
