Patient Protection Program
Before filing a complaint about health insurance, please read this important information.
If a health care treatment or service was denied, reduced, or terminated by your health plan, you may have the right to request an external review as long as ALL of the following apply:
- You have received a letter from your health plan advising you of its decision not to provide coverage because the treatment or service is NOT MEDICALLY NECESSARY
- It has not been more than 60 DAYS since you received the letter of denial from your health plan
- You have completed the health plan's INTERNAL REVIEW PROCESS
- Without coverage by the plan, the disputed treatment or service (plus all related services) would cost you MORE THAN $500
If all of the above apply, immediately advise your health insurance plan that you wish to exercise your rights for an EXTERNAL REVIEW of your denied, reduced, or terminated health benefits. Your health plan will advise you of the specific steps that will be followed in this process.
If the health plan's reason for denying benefits is for something other than medical necessity, please complete the Ohio Department of Insurance Consumer Complaint Form.
PLEASE NOTE: If you have not completed the plan's internal review process, you should contact the plan now to start this first step of your appeal. You must go all the way through the plan's internal review process before you can proceed any further.
If the health plan has denied benefits because it has determined the service or treatment is not medically necessary, BUT the disputed care would cost you $500 or less, you may wish to contact your attorney. The Ohio Department of Insurance has no authority over matters of medical necessity.