Impatient

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4 tips for resolving those frustrating health insurance problems

If your insurance plan won’t cover a particular service or a specific medication, you can file a grievance with the plan. You can also contact the Department of Managed Health Care.
If your insurance plan won’t cover a particular service or a specific medication, you can file a grievance with the plan. You can also contact the Department of Managed Health Care. /iStockphoto.com

Yesterday I introduced you to Will Allen, who wrote to Impatient because he was extremely frustrated trying to get authorization from his sister's health insurer to treat her chronic back pain. 

He asked for help resolving the problem, and I directed him to the Department of Managed Health Care. But as Will and I learned, the department deals with second-level appeals. So they referred him to the Health Consumer Alliance, a partnership of consumer assistance programs operated by community-based legal services organizations.

I reached out to Stephanie Lee, supervising attorney for the Health Consumer Center Project at Neighborhood Legal Services of Los Angeles County, to find out what people should do if they are beyond frustrated with their health insurance provider.

Here are Lee's three tips for resolving these problems:

1. Contact the Health Consumer Alliance, or one of its affiliated organizations

If you're having trouble with your insurance, you can contact one of these groups. The toll-free number is 888-804-3536; this page lists the phone numbers for the county-level health consumer centers.

Lee says the Health Consumer Center Project provides assistance for a wide range of problems. Recently, the most common complaints are from people who purchased new insurance, and later learned that the doctor they trust, or the medication they rely on, is no longer covered.

2. File a grievance with your insurance company

If your insurance plan won’t cover a particular service or a specific medication, you can file a grievance with the plan. If there’s a very urgent medical need, you can request an expedited grievance, Lee said.

Groups affiliated with the Health Consumer Alliance can help you with this process.

3. File a complaint with the Department of Managed Health Care

If you filed a grievance with your insurance company, and you don’t receive a response in 30 days, or if the situation is not resolved in a positive manner, the next step is to file a complaint with the Department of Managed Health Care, Lee said.

Groups affiliated with the Health Consumer Alliance can assist you with this step, too.

"Most of the time, we are generally able to resolve the issue without contacting the Department of Managed Health Care," Lee said.

4. Get your doctor's support

In situations in which a doctor prescribes a medication but the insurance company won't cover it, it's helpful for patients to request a letter of support form their doctors, outlining why the medication is needed, Lee said.

"It's really important for people to talk with their doctor, and have the support of their doctor," Lee said.

Have you had to file a complaint with your health insurance company? How effective and efficient was the process? Tell us about it in the comments below, or e-mail us at Impatient@scpr.org. Your story could help inform a future blog post.

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