Do complaints about insurance companies go to the Insurance Commiss. in your state, or the state of the co.?

Question

Our health insurance company has been promising to pay for a costly doctor's visit, but then, instead, they have sent out explanations of non-payment. I have been on the phone with them repeatedly for the past 4 months, and each time the rep says that they certainly should pay it, and that I can count on it being paid. But then, again, they don't. I have finally decided to take it to the insurance commissioner. The company's corporate office is in PA. Do I complain to the PA Insurance Commissioner, or to the Ins. Commissioner of my state?

Also, should I decide to take them to small claims court, would I have to go to PA, or would the court take place in my state?

Thanks for any feedback.

Answer 1

Go to the Insurance Commissioner's office in your state.  Each state licenses and regulates the companies operating in that state so have authority over  those companies.  As far as action against the company I doubt from your statement above "costly doctors visit" if it would fit the criteria that a small claims court has as far as dollar value.  You can try it and see otherwise you need to contact an attorney.

Answer 2

If the plan is 'self funded' (by the employer) file it in your own state.

If its traditionally funded, file it in the state the policy was written. That may, or may not be in PA.

Call your insurance company & ask if the plan is self funded.

& ask what state's regulatory requirements they comply with.

Why are they denying the service? This could affect who you file to as well. good luck.

ps. if your insurance is self funded, you'll have better luck complaining to corporate HR.

Answer 3

Always file the complaint with the Insurance Commissioner of the state you live in. No other state will help you like your own.

The insurance company has to answer to your states Ins Commish since the company is licensed by the Ins Commish to do business in your state.

FYI, most insurance policies have a clause in them that states the policyholder can't sue their own insurance company. The policy normally will require some kind of arbitration or mediation between the policyholder and company. This is a good ? to ask your Ins Commissioners office.

Good Luck

Answer 4

Your state.