April 7, 2014
Some patients are
asking where they can turn if and when they have questions or problems with
their Affordable Care Act (ACA) marketplace insurance. “Hey Doc” tackles the
question in this week’s 22nd installment of Texas Medical Association’s (TMA’s)
“Hey, Doc” weekly education campaign.
What do I
do if I'm having problems with my marketplace plan?
If you are having
problems with your marketplace plan — for example, you aren’t getting the
coverage you were promised, or the plan isn’t paying your claims — you have
certain rights and ways to get those problems fixed. Health plans must give you
a way to report and resolve complaints, but sometimes they only give you a
certain amount of time to take action. So it’s important to check your
insurance paperwork and contact your health plan right away if you are having trouble.
You might also have to gather some documents to show the problems you are
If this doesn’t
help, or if your health plan is not communicating with you, you can also file a
complaint with the Texas Department of Insurance (TDI).
The complaint must
be in writing, and you can find the form and instructions online at www.tdi.texas.gov/consumer/complfrm.html.
Then submit the complaint:
If you need more
help filing a complaint, call TDI’s toll-free Consumer Help Line at (800)
media: TMA makes this content available for you to reference or publish. TMA
physician experts are available to answer your questions. For more information on the ACA health
insurance marketplace check out TMA’s Hey Doc video series, MeAndMyDoctor.com, and HeyDoc.texmed.org.
TMA is the largest state medical society in the nation,
representing more than 47,000 physician and medical student members. It is
located in Austin and has 112 component county medical societies around the
state. TMA’s key objective since 1853 is to improve the health of all Texans.
Contact: Pam Udall
cell: (512) 413-6807
Contact: Brent Annear
phone: (512) 370-1381
cell: (512) 656-7320
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Check out MeAndMyDoctor.com for interesting and timely news on health care issues and policy.