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Channels for filing regulatory health insurance complaints? Florida

Discussion in 'Health Insurance, HMO, HIPAA & Disability' started by root, Feb 16, 2022.

  1. root

    root Law Topic Starter New Member

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    Jurisdiction:
    Florida
    I live in FL. Employer / policy is from state of Washington.

    Health insurance is self-funded by employer.

    Mid plan year, my insurance provider negatively reduced coverage on 2 occasions on 2 different health policies (as it relates to Covid). These changes were not communicated in any formal fashion (including letter, email, etc). Their reasoning for lack of communication is because the policies are not formalized and were dynamically changing. It is admitted by the company that there are no records of the changes being communicated to me. (They had 6+ months as an example from change in policy till a claim of mine was denied because of a change in that policy)

    My expectation is for negative changes (or really... changes in general) to take effect at the start of a plan year.

    The health insurance provider states I can file a grievance, which are only internal to the provider, however I feel this isn't adequate and doesn't push accountability / punishments.

    What regulated or government agencies can I file these types of complaints / issues with?

    The resources I've found pertain to complaints against health care providers (like hospitals, doctors, etc), but nothing relating to health insurance companies.
     
  2. PayrollHRGuy

    PayrollHRGuy Well-Known Member

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    Last edited: Feb 16, 2022
  3. adjusterjack

    adjusterjack Super Moderator

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    Each state has an insurance department that regulates insurance.

    The US DOL regulates employee benefits under ERISA.

    You can file your complaints with all three if you like.
     
  4. cbg

    cbg Super Moderator

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    Don't expect anything more than a "thanks, we'll look into it" from any of them. You will NOT be notified of what action is taken, or even if action is taken.
     

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