Potential Government or Employer Help
Potential Government Help
Every state’s insurance regulator offers consumers an opportunity to “file a complaint” or to otherwise ask for help with an insurance claim. Some states offer on-line submissions, some offer “live” assistance, and many will help you find additional resources that may be helpful.
Search by state for your insurer regulator at the National Association of Insurance Commissioners (NAIC) website: https://content.naic.org/state-insurance-departments
The Employee Benefit Security Administration (EBSA) offers help with private company employee benefits plans, including for mental health benefits at:
- 866-444-EBSA (3272)
- https://www.dol.gov/agencies/ebsa/about-ebsa/ask-a-question/ask-ebsa
Your state and federal elected officials may be helpful in navigating insurance company obstacles.
Learn who your elected officials are here: https://myreps.datamade.us/about.
Be prepared to share:
- Name and policy information of your health insurer
- Describe the type of care you require
- Describe the obstacles you have encountered
- Describe what you have done to overcome the obstacles, such as:
- Requests to health insurer customer service reps
- Medical necessity letter
- Insurer formal complaint
- State regulator complaint
- Other steps
- What satisfactory resolution of the issue would be
Potential Employer Help
Employers can be advocates for overcoming insurer obstacles, though only if they know you need the help. This template can be customized to request your company’s support with a denial for “not medically necessary.
This request does not require that you share your private health information.
Employers can be advocates for overcoming insurer obstacles, though only if they know you need the help. This template can be customized to request your company’s support when no in-network provider is available.
This request does not require that you share your private health information.
Employers can be advocates for overcoming insurer obstacles, though only if they know you need the help. This template can be customized to request your company’s support with an obstacle related to telehealth.
This request does not require that you share your private health information.
“Single case agreements” are one-time exceptions to an insurance policy.
Some large companies may consider a request for a single case agreement. Your company’s human resources or benefits department may provide guidance on this possibility.
To learn more, visit Pushing Further with Your Insurer
