Monday, April 7, 2014

How To Handle Problems With Your ACA Marketplace Insurance Plan

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 TMA’s“Hey, Doc” weekly education campaign.



Q: What do I do if I'm having problems with my marketplace plan?

A: 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 having.

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) 252-3439.

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