Requesting Health Insurance Claim Help from Federal Agencies

Part 1: The Basic Tools, Chapter 3: Developing a Systematic Approach to Dealing with Health Insurance Page 20

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Your request for help should probably be addressed to a federal agency rather than to a state agency if the claim problem appears to relate to an issue in regard to which the federal government has passed a specific law. At this point, federal laws deal with a number of health insurance issues, including

• coverage for pregnancy and childbirth;
• yearly or lifetime benefit maximums for the treatment of mental or emotional illnesses;
• transfers from one group health insurance plan to another;
• extensions of group health insurance after divorce or after leaving a job;
• coverage under a self-funded plan;
• discrimination on the basis of disability;
• issues related to Medicare, Medicare HMOs, Medigap policies CHAMPUS, or Medical Savings Accounts.

If the issue relates to a specific federal law or regulation, you'll also need to identify the appropriate federal agency. Issues that involve self-funded plans or extensions of private group health insurance plans under COBRA should be directed to the Pension and Welfare Benefits Administration of the United States Department of Labor. Issues that involve extensions under COBRA of health insurance plans sponsored by state or municipal government agencies should be directed to the United States Public Health Service. (See Appendix B for information on how to contact these agencies.)

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