Information about the Virginia Health Insurance Managed Care Ombudsman

The principal function of the Office of the Managed Care Ombudsman is to help Virginia consumers who have health insurance provided by a Managed Care Health Insurance Plan (MCHIP). The office was created to promote and protect the interests of persons covered under MCHIPs in Virginia.

The Office of the Managed Care Ombudsman CAN:

• Answer inquiries and questions about MCHIPs and managed care;
• Help individuals understand and pursue their rights of appeal of adverse decisions made by MCHIPs upon receipt of a signed inquiry form or letter from the consumer requesting assistance;
• Answer questions about regulatory requirements affecting MCHIPs and provide information about health benefits mandated by Virginia law; and
• Develop written information describing different types of MCHIPs and make such information available to consumers, as it is available.

The Office of the Managed Care Ombudsman CANNOT

• Investigate or resolve complaints, but it can refer individuals who have a complaint to the internal review mechanisms at the MCHIP or to the appropriate government agency.
• Require that benefits are paid, but it can assist you in understanding your rights, and it can help you through the appeal process.

To Contact The Office of the Managed Care Ombudsman:

P. O. Box 1157
Richmond, VA 23218
Telephone Toll free (877) 310-6560
Or locally (804) 371-9032
Or log onto the Bureau's website, click on
"Consumer"
and click on the link to
"Office of the Managed Care Ombudsman"