Requesting Health Insurance Help from Government Agencies or Private Organizations
Part 1: The Basic Tools, Chapter 3: Developing a Systematic Approach to Dealing with Health Insurance Page 18
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Step Six: Establishing A System For Requesting Help from Government Agencies or Private Organizations
Claim-processing problems may result from communications difficulties or data entry errors, or from difficulties in understanding an insurer's requirements for specific information or documentation. Such difficulties can often be resolved in a satisfactory manner through the appeals process.
However, there are times when an insurer and a consumer may disagree on the interpretation or application of specific health insurance policy rules or state or federal laws or regulations. Where significant amounts of money are involved, or where a specific principle is at issue, it's often important for consumers to request help from private, state, or federal agencies or organizations in resolving a particular problem.
The first step in the process is to try to determine the organization or agency to which your request for help should be addressed. Addressing the request to the wrong group simply delays the matter. The most important factor in deciding which organization or agency to contact has to do with whether the issue relates primarily to state or to federal laws or regulations. Unfortunately, given the chaotic nature of the current health insurance system, that's not always easy for a consumer to determine.
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