Ohio OH Health Insurance Problem

Reader’s Question:

This did not happen to me! I have a co-worker who is having the worst time. Her health insurance carrier has not paid for a claim she had one year ago. Now, she has people calling her home. As we have the same health insurance plan, I am worried. Any advice?

Marianne

Toledo, OH

Interesting question, Marianne,

Without the specifics of the dispute, we rely on experience. Non-payment of legitimate health care expenses is serious and rare. We are assuming your co-worker has a legitimate health claim as described in your group policy. If that is the case, then it is definitely not too late.

Most health insurance payment issues are a matter of communication. Your co-worker needs to gather the facts. She should speak with the provider who has not received payment and gain an understanding of the dispute. At that point, your friend should contact her health insurance agent and request assistance. Either the agent or your friend should then contact the claims manager of the health insurance carrier.

If her case is valid and she des not receive satisfaction, the sate insurance department should be notified. Health insurance issues are regulated by the state insurance department.

If those steps do not lead to resolution an attorney who specializes in health insurance should be consulted. This would be a very rare case though. Again health insurance issues are usually the result of poor communication. To make it an easier the process, establish a good communication practice with your insurer.