If you’ve ever had health insurance, it’s likely you’ve encountered a problem at one time or another. It’s not that insurance companies are trying to shirk their responsibilities (though it may seem like that sometimes), it’s just that health insurance can be complicated. Working with your insurance company can be too.
We’re the Utah Insurance Department and we’re here to help you through what can sometimes be a difficult process. Below are five of the most common health insurance problems that we hear about, and what you can do should you encounter one of them.
1. My insurance company isn’t giving me the amount I think they should. Is there anything I can do?
Trying to solve an issue with an insurance company can sometimes feel like an insurmountable task. But if you feel like you’re not being treated fairly, call us at 801-957-9200 with your concerns. We’re here to help you. We’ll listen to you and the issue you’re having to determine if you have a legitimate complaint. If you don’t, we’ll help you understand why your insurance company was correct. But if your problem is legitimate, you can file a complaint and we will investigate. This really is a complicated process. Don’t try to do this by yourself. Leave it to the pros at Utah Insurance Department.
2. How do I know if my doctor is covered under my plan?
Knowing the answer to this question is extremely important. Because your share of the cost for health care services will likely be different for in-network providers and out-of-network providers. The Utah Insurance Department won’t have this information, but there are several ways to find out if your doctor is covered under your plan.
First, go to your insurance company’s website and look for your doctor’s name on their provider list. Then call your insurance company and ask if your doctor is covered under your plan (make sure you have your plan information when you call). Finally, call your doctor’s office and make sure they will accept your insurance plan.
3. What if I don’t fully understand my policy?
Let’s face it. Health insurance can be complicated. With co-pays, premiums, coinsurance, deductibles, in-network, out-of-network, it’s easy to get confused. And as much as we’d like to help you with a question about your particular plan, that’s not the role of the Utah Insurance Department. We’re here to make sure the marketplace is working for you and other consumers and the insurance companies.
So if you have a question about your policy, talk to your insurance agent or call your insurance company. That’s why they are there. The company or your agent can walk you through your policy and make sure you clearly understand your policy. And their services come at no cost to you.
4. My claim was denied. Is there anything I can do?
When you need medical care, the last thing you want to worry about is whether your health insurance will cover it. Unfortunately, your medical claim may be denied for many reasons. But you DO have some recourse to get the insurance company to reverse its decision.
Your health insurance policy includes an appeal process. Call your insurance company or your agent and ask them to help you with filing an appeal. Don’t delay: There are time limits to filing your appeal.
If you still can’t fix the issue, call us. We’re the Utah Insurance Department, and we’re here to help.
We can look at your policy, and if the insurance company rightfully denied your claim, we’ll help you understand the reason why it was denied. But if your point is legitimate, you can file a complaint and we will investigate.
5. How can an insurance agent help me?
Most people wouldn’t go to court with a lawyer or buy a house without a real estate agent. It’s the same with health insurance. An insurance agent knows health insurance inside and out. An agent can answer any question and allay any concerns you might have during this complicated process.
If you don’t have an insurance agent, check out our Licensee Search tool. Just enter your address to find an agent near you. And, remember, health insurance agents get paid by the insurance companies. There is absolutely no cost to you to get their advice and recommendations. So don’t wait. Contact an insurance agent, and get started on the Open Enrollment process today.