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.