Problem with your mental health insurance coverage? Here’s how to file a complaint or appeal

FILE

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FILE

You have the right to file a complaint if you think your insurance company isn’t properly covering mental health benefits.

First, try to solve the dispute yourself

Many complaints are resolved this way.

Call the insurance company’s customer service number and talk to an agent. If they don’t fix the problem, ask to speak to a supervisor. It helps to have your policy number ready before you call. This can usually be found on your insurance card.

Ask for a written response to your complaint so you have a record of the answer the insurance company gives you. Follow up in writing. Describe your complaint and how you want the company to resolve it.

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If the issue is that your plan refuses to pay for care or denied a claim that you feel should be covered, the National Alliance on Mental Illness has a template letter that could help you. To find the template, go to nami.org/Your-Journey and click on “individuals with mental illness” and then “understanding health insurance” and then “how to file an insurance complaint.”

If you can’t solve it this way

If that doesn’t work, you still have options.

If you can’t resolve a problem with your insurer, you can file a complaint with whatever regulatory agency your type of insurance plan falls under. Officials will check whether your insurance plan handled your issue correctly under the terms of your plan.

When you are ready to file a complaint with a regulator, it helps to first gather:

  • The name of your health plan and your insurance ID card.
  • Have a description of what happened and who was involved.
  • Copies of letters or messages between you and your insurance company.

Is your health plan through your job and a fully insured plan? Or did you buy it through the Affordable Care Act Marketplace?

Then the Ohio Department of Insurance is who you call. Contact Ohio’s consumer services hotline at 800-686-1526, Consumer.Complaint@Insurance.Ohio.gov, or fill out a complaint form online at insurance.ohio.gov.

Do you have a self-insured plan?

Some companies, especially large companies, have self-insured plans. If that’s the case, you might have a name brand on your insurance card like Aetna or UnitedHealthcare — which handles the administration — but your insurance claims are actually paid for by your employer.

If you have a self-insured plan, you can file a complaint with the U.S. Department of Labor by calling 859-578-4680 or at DOL.gov.

Have Medicaid?

You can call the Ohio Department of Medicaid consumer hotline at 800-324-8680 or try medicaid.ohio.gov.

Have Medicare?

If shopping for plans in open enrollment season, Ohio Senior Health Insurance Information Program hotline experts at 800-686-1578 can help consumers understand what mental health care and medications different plans cover.

Medicare does not have to follow parity laws, except for cost-sharing for outpatient mental health services.

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