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  1. #1
    Join Date
    Jun 2008

    Default Who Do I Complain To?

    My question involves insurance law for the state of: California

    My daughter has been having a slew of problems with her medical insurer. They have denied service, but have not responded as to what her recourses are. She was told that she has been assigned a caseworker from their Appeals and Grievances Department, but we have not been able to get that individual to respond to emails or phone calls. When I called this morning another woman--whose name I was given as being involved in the case -- was exceedingly rude and basically told us to find someone else to help us.

    I have never had the experience of having an insurer be so intractable. I would like to complain about the lack of service but have been unable to determine who would actually oversee them, and not be part of their problem. Hospitals have a patient liaison. Do insurers have someone looking out for the customer?

  2. #2
    Join Date
    Oct 2006
    supratentorial region

    Default Re: Who Do I Complain To?

    You can always make a complaint with your state's Insurance Commission. However, I wouldn't expect much to happen.

    As cbg pointed out in your earlier thread, the insurance company does not have to change it's policy to pay for your daughter's treatment.

    Basically, they're not saying "don't treat her", they're saying "we won't pay for her treatment".

    How did her appointment go with the other specialist?

    ETA: please keep all questions about this issue in your original thread.

  3. #3
    Join Date
    Mar 2008

    Default Re: Who Do I Complain To?

    i suggest you get a copy of her plan booklet and read it since the information is probably in there. as previously indicated, your daughter is not being denied treatment, just that the medical insurance plan is not paying benefits for her services. did you follow the rules of the plan? is this an HMO, PPO plan and do they suggest that you have to have certain pre-certifications or referrals? if you did not go by the guidelines set forth in the plan than there is no one to complain to but file a grievance

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