How to get health insurance claim paid in Ohio
Reader question:
I live in Cincinnati and my health insurance claim was recently denied. I think it was wrongly denied. What do I do?
Maddie
Great question.
I’m sorry that you’re having to go through this, Maddie. I know I worry about paying bills often that I know I have enough money to pay, so I can imagine what it is like when you get a necessary service that you should be covered for and then find out that the payment is all on you. It doesn’t have to be that way, though. If you feel that your health insurance company has wronged you by denying a claim of yours, then you can file a complaint with the Ohio health insurance department so that they can research your complaint to find out who was in the right.
Before you file a complaint you should be very sure that you were wronged, because it doesn’t make the ODI very happy to be looking into false claims. In order to be sure that you are in the position to have the right to file a complaint, you have to meet every single one of the following criteria.
- You got a treatment or medical service that you assumed was covered by your health insurance plan, but your provider has informed you that they aren’t paying because it wasn’t medically necessary.
- You have waited two months since receiving a letter stating that you will not be covered for this service.
- You have already gone through the internal review process with your health care provider and are still denied.
- The treatment or service that you were not covered for would have you pay more than five hundred dollars.
If you meet that criteria, go ahead and file a complaint through the Ohio Department of Insurance website or through one of their physical offices.
Cheers,
Fashun Guadarrama.
What you need to know about group health insurance
There are about five things about group health insurance that lots of employers don’t know but should. Providing group health insurance for your employees is a big deal, and you should educate yourself as much as you can about it. Most employees can agree that they want to get the cheapest group health insurance that they can, but also realize that they need to get quality group health insurance for their employees. If you’re sincere about this desire, it’s important to know as much as you can about group health insurance rates.
- Competition and law. There’s a lot of it going on in the state of Texas, especially in the Houston the health insurance business. It’s also regulated by the Texas Department of Insurance, which enforces the Insurance Code. Every year new laws make insurance policies even more complex than ever before and make it more expensive for companies to get group health insurance plans. The congress in your state has an effect on what you’re paying for group health insurance.
- Lying about rates. Group health insurance agents try to get more customers by lying and saying that they can get you cheaper health insurance rates. That’s not the case. Considering that group health insurance is regulated by the state, the prices are the same all across the board among agents.
- Agents don’t really know. Agents don’t know what insurance companies’ rates will actually be, they can only guess. It will depend, in the end, on the company and on each employee employed by it and their medical condition. If you have a company with as few as 50 employees, you can get rates from an agent that up to 67% off from what you’re going to get from the actual insurance company.
- Bribes. Getting some gifts for giving your business to a group health insurance agent may seem like it’s okay and many might not realize what it really is. Exchange of cash or gifts can make the group health insurance agent lose his or her license and is against the law.
- Knowledge. Just because group health insurance agents can’t know for sure how much a certain insurance company is going to charge, they can still help your company save up to hundreds of thousands of dollars on group health insurance costs. Things like programs that help employees maintain themselves in good health can contribute to these huge savings.
Cheers,
Fashun Guadarrama.