Legal Words of Wisdom: Dealing with Insurance Companies

Rodney Warner, Esq
Legal Clinic for the Disabled, Inc.
Last Modified: November 7, 2008

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Your patient is getting nowhere with her insurance company. Multiple calls to the toll free “help” line either results in conflicting information or an endless computerized phone tree from Hell.

If you are facing insurance coverage problems, there are some resources that may be able to help. One option may be your state’s Department of Insurance website (Find your state’s website). These departments regulate most health insurance providers and offer many resources for consumers. They don’t regulate “self insured” health insurance policies that fall under the federal ERISA law.

Among the many resources that may be on these websites are tools to help you find a licensed insurance agency, learn about insurance products, how to obtain health insurance or learn about your rights as a consumer. These departments also have toll-free consumer lines. They can be found on their websites.

Complaints about insurance coverage can be filled with these departments. If the department finds in favor of the patient, they can order an insurance company to cover disputed medical costs. Investigations might be expedited in the case of a medical crisis. Your state Department of Insurance websites may have complaint forms and many allow online filing of complaints. Some states offer access to the complaint history of insurance companies, so you may be able to check a company’s history before contracting with them for insurance.



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