A problem with your mental illness insurance coverage? Here’s how to file a complaint or appeal

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To exploreHow a mental health hotline helped Dayton residents weather the pandemic

If the problem is that your plan is refusing to pay for care or denying a claim that you think should be covered, the National Alliance on Mental Illness has a sample letter that may help. To find the model, go to nami.org/Your-Trip and click on “people with mental illness” then on “understanding health insurance” then on “how to file an insurance complaint”.

If you can’t solve it this way

If that doesn’t work, you still have options.

If you are unable to resolve a problem with your insurer, you can file a complaint with the regulatory body responsible for your type of insurance plan. Officials will check to see if your insurance plan has properly handled your issue under the terms of your plan.

When you’re ready to file a complaint with a regulator, it’s helpful to first gather:

  • The name of your health plan and your insurance ID.
  • Have a description of what happened and who was involved.
  • Copies of letters or messages between you and your insurance company.

Is your health plan tied to your job and a fully insured plan? Or did you buy it through the Affordable Care Act marketplace?

Then the Ohio Department of Insurance is the one you call. Contact the Ohio Consumer Services Hotline at 800-686-1526, Consumer.Complaint@Insurance.Ohio.gov, or file a Claim Form online at insurance.ohio.gov.

Do you have a self-insured plan?

Some companies, especially large companies, have self-insured plans. If so, you may have a brand on your insurance card like Aetna or UnitedHealthcare – which handles the administration – but your insurance claims are actually paid by your employer.

If you have a self-insured plan, you can file a complaint with the U.S. Department of Labor by calling 859-578-4680 or DOL.gov.

Have Medicaid?

You can call the Ohio Department of Medicaid Consumer Hotline at 800-324-8680 or try medicaid.ohio.gov.

Have health insurance?

If you’re shopping for plans during open enrollment season, experts at the Ohio Health Insurance Information Program hotline at 800-686-1578 can help consumers understand what different plans are. mental health care and medication cover.

Medicare is not required to follow parity laws, with the exception of cost sharing for outpatient mental health services.

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