FAQ: I have exhausted all appeals options through my insurance carrier. Is there anything else that I can do?

Medical benefits are not an exact science, and sometimes it is necessary to appeal the processing of your claims with your insurance carrier. Should you receive a denial to your claim from your insurance carrier, exhaust all appeals processes with you insurance carrier, and still believe that your claim should be reprocessed, you are able to appeal through your state’s department of insurance.

The Ohio Department of Insurance is able to provider consumer information and can investigate complaints involving insurance companies and agents. As noted on their site, the department cannot:

·         Act as your legal representative, or give you legal advice

·         Recommend insurance companies or HMOs

·         Force a company to give you what you want if no laws have been broken

·         Make determinations about medical necessity

·         Address problems with your employer's self-funded health plan, unless the plan involves an insurance company, an HMO or an independent administrator that is licensed with the Department

If you have exhausted your appeals process with your insurance carrier and choose to appeal through the Ohio Department of Insurance, you can do so by completing the following complaint form and submitting it per the instructions provided by the ODI.

Consumer Complaint Form