The ISMA meets with IDOI to rescind minimum claim rule
A new policy adopted by the Indiana Department of Insurance (IDOI) may be the reason complaints against health insurers have decreased by 7.21 percent. Last year, the department limited the value of claim complaints to $250 or more.
“We have been working with the IDOI for the past year and met with them again July 14 to ask that they remove this rule,” said Mike Rinebold, the ISMA’s director of Government Relations. “The $250 dollar amount was an arbitrary amount. So, physicians feel the smaller legitimate claims will not be paid, which in effect hurts patients.”
IDOI officials informed the ISMA that multiple claims bundled to total $250 will be accepted, as long as they involve the same insurer. However, the action would be recorded as one complaint against that insurer.
The ISMA will meet again with the IDOI to continue discussion about the rule, noted Rinebold.
The IDOI complaint index is based on each company’s statewide premium total and the number of closed complaints against the company. A complaint index of 1.00 means that the insurer’s share of all complaints received is equal to its share of all the business written in Indiana. An index of 2.00 means that the insurer’s share of complaints is twice as large as its share of business.
Filing a complaint
While the IDOI cannot collect for services rendered, it can investigate facts concerning claims. The department can help physicians when efforts to resolve a problem have not been successful and payment on a clean claim is more than 90 days late.
To file a complaint, physicians should provide in writing:
- A cover letter describing the problem and how you think the problem should be solved
- Complete name and address of the insurance company
- A copy of the patient’s insurance card
- Policy information such as the insured’s name, patient’s name and group/member/policy numbers
- Information on claims involved, such as claim number, date of service, date filed with insurance
Find additional information and complaint forms at this link. Or call the IDOI at (317) 232-2395.
See the complete complaint index on the in.gov website.
Report does not include 253 companies with zero complaints.
Complaint indices do not include Medicare or Medicaid Premiums.