Information About the Ohio Department of Insurance

About the Ohio Department of Insurance

The Ohio Department of Insurance is one of the state's largest consumer protection agencies. Our professionals offer free and objective information to help Ohioans understand insurance and resolve certain issues they may experience.

Filing a consumer complaint with the Ohio Department of Insurance

If you believe your health plan is failing to pay a claim or denying a service or treatment that appears to be covered in your contract, and you've completed any internal process the plan has to review such appeals, contact the Ohio Department of Insurance Consumer Services Division.

Call Consumer Services:
1-800-686-1526.

Before the Department can investigate, you must submit a written complaint. We can mail you a copy of our form to complete and return or you can use a copy of the form printed in this guide, across from page 28.

You can also visit the Department web site (www.ohioinsurance.gov) to download the form or complete our online form.

We will send the insurance company a copy of the complaint, and ask them to resolve it or explain its position. Insurance companies are required by law to respond to the Department. We will review all the facts to make sure the carrier has followed its contract with you, and that it has complied with insurance rules and laws.

Provider complaints

Healthcare providers can submit a complaint by visiting the Department of Insurance web site (www.ohioinsurance.gov) and completing a Prompt Pay Complaint Form. Providers should follow all contract grievance and appeal procedures before filing a complaint with the Department.

About the regulatory authority of the Ohio Department of Insurance

In most cases, the Ohio Department of Insurance is authorized to make sure covered people get benefits as written in their health policy. In the case of "self-insured" plans, however, Department of Insurance authority may be limited. See page 3 for general information on self-insured plans. The Ohio Department of Insurance cannot make decisions about medical necessity. See page 24 on appealing plan decisions.

The Ohio Department of Insurance does not regulate the benefit or cost structure of group plans. As long as the contract meets Ohio's legal requirements, contract details are up to the policy owner. Such factors can include your right to extra benefits or the premium amount you pay for coverage. See pages 6-8.

The Ohio Department of Insurance does not set insurance company premiums or rates. Each insurance company calculates its own premiums. For true individual policies, the Department reviews the rates and makes sure the insurance company meets Ohio's legal requirements.

Please note: most "individual" policies sold today are issued through an association group. Insureds receive a certificate instead of a policy. Group rates are not regulated by the Department of Insurance.