Dealing with Insurance Companies

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By Melanie (Logan) England
(this information formerly on the EBmommas website)

Ignorance is not bliss. 90% of Epidermolysis Bullosa related claim denials from insurance companies are due to ignorance of this rare disease. As if you did not have enough to do, it is now your job to educate them on EB. People who have never seen a child with EB simply cannot fathom why we need all these bandages. Here are some steps to take to get your insurance company to work for you:

-Ask your doctor to write a plan of treatment that details the types and amounts of bandages needed for each dressing change and how often dressing changes should be done. Send a copy to your insurance company. Often since mom or dad knows the family routine best the doctor will allow you to write this yourself then they will review and “sign off” on it.
-Insist that your insurance company assign you a case manager. Having one person who can become familiar with both EB and your individual case can be invaluable. Send the case manage pictures of your unbandaged child. Pictures speak a thousand words.

Getting your claims processed

-Keep a copy of EVERYTHING! It’s much better to deal with piles of papers that to find you are missing an important form or piece of documentation.
-At each doctor’s appointment or hospital stay ask for at least two itemized copies of your bill. One for you, one for the insurance company. Almost all insurance companies will require an itemized bill rather than a receipt.
-If you have to complete your own claim forms, ask your insurance company to send you a stock of forms so you don’t run out. Make a copy of each form you fill out for your personal records, recording on it the date you mailed it in.
-Deal with a pharmacy that uses a computer system that allows them to make you a printout of all your prescriptions.

What to do when a claim is denied

-Ask your insurance company for a claim rejection in writing specifying why the claim was denied.
-Immediately file an appeal. Ask that your claim be examined by the companies’ medical review board.
-Ask each and every doctor or therapist who follows your child’s care to write a letter to the company on your behalf. Ask that they detail why the treatment or prescribed item is medically necessary and the possible complications of your child not receiving them. Keep a copy of these letters for your records.
-The best way to get a timely response for your appeal is to politely state in your letter that you will expect a response within a set period of time (ie;30 or 60 days), or you will contact your state insurance commission.
-Keep a phone log of every phone call to and from your insurance company. Note the date, time, who you spoke to and a summary of the conversation.
-Provide the insurance company with as much information as possible that supports your claim. Photographs, medical records, medical articles, and names of insurance companies that do pay for the same services or supplies.

What to do if none of the above works

-If you don’t receive a timely response or your appeal is denied, do contact your state insurance commission. Send copies of all the denied claims, all the documents you provided the company, a copy of your phone log and all of their written responses to you. State in your letter that you are filing a formal complaint about the company. The commission will document your complaint and ascertain if any further action can be taken against the insurance company. Below is a listing of the address and telephone number of all 50 states insurance commissions. We also recommend to check out information provided from the Insurance Partnership company, which is one of the best companies you could rely on now a days

Alabama Department of Insurance
135 South Union Street
Montgomery, AL 36130
Phone: (334) 241-4126…..Licensing Manager
Phone: (334) 269-3550

Alaska Division of Insurance
Anchorage Office:
3601 C Street, Suite 1324
Anchorage, AK 99503-5948
(907) 269-7900 (phone)
(907) 269-7910 (fax)
Juneau Office:
9th Floor State Office Bldg
333 Willoughby Ave (99801)
PO Box 110805
Juneau, AK 99811-0805
(907) 465-2515 (phone)
(907) 465-3422 (fax)

Arizona Department of Insurance
INSURANCE LICENSING SECTION
2910 North 44th Street, Suite 210
Phoenix, Arizona 85018-7256
Phone: (602) 912-8470
Fax: (602) 912-8453

Arkansas Insurance Department
1200 W. Third St.
Little Rock, AR. 72201
Phone: (501) 371-2600

California Department of Insurance
License Bureau
320 Capitol Mall
Sacramento, CA 95814
E-Mail: General Information
Phone: (916) 322-3555

Colorado Division of Insurance
1560 Broadway, Suite 850
Denver, CO 80202
Phone: (303) 894-7499

Connecticut State Department of Insurance
LICENSING DIVISION
P O Box 816
Hartford, CT 06142-0816
Phone: (860)297-3845
Fax: (860)297-3872
Director: Raymond Claytor

State of Delaware Insurance Commissioner’s Office
Wilmington Office:
1st Federal Plaza
710 North King Street
Wilmington, De. 19801
Phone: (302) 577-3119

Dover Office:
841 Silver Lake Blvd
Rodney Building
Dover, De. 19903
Phone: (302) 739-4251

Florida Department of Insurance
200 East Gaines Street
Tallahassee, Florida 32399-0300
Phone: (904) 922-3100

Georgia Insurance Department
716 West Tower
2 Martin Luther King Jr. Drive
Atlanta, GA 30334
Phone: (404) 656-2070
Phone: 1-800-656-2298

State Of Hawaii Insurance Division
250 S. King Street, 5th Floor
Honolulu, Hawaii 96813
Phone: (808) 586-2790

Idaho Department of Insurance
Licensing Division
700 West State Street
P.O. Box 83720
Boise, Idaho 83720-0043
Phone: (208) 334-4342
Fax: (208) 334-4398

Illinois Department of Insurance
320 West Washington Street
Springfield, Illinois 62767-0001
Phone: (217) 782-4515
FAX: (217) 782-5020
TDD: (217) 524-4872
or
Illinois Department of Insurance
100 West Randolph
Suite 15-100
Chicago, Illinois 60601
Phone: (312) 814-2427
FAX: (312) 814-5435
TDD: (312) 814-2603

Iowa Insurance Division
Lucas Building, 6th Floor
Des Moines, IA 50319
Receptionist: (515) 281-5705
E-mail: General Info.

Kansas Insurance Department
420 SW 9th St.
Topeka, Ks. 66604
Phone: 913-296-3071
Fax: 913-296-2283

Kentucky Department of Insurance
Agent Licensing Division
Post Office Box 517
Frankfort, KY 40602
Toll Free: (800) 595-6053
Phone: (502) 564-6004
Fax: (502) 564-6090

Louisiana Department of Insurance
Office of Licensing & Market Compliance
950 N. Fifth St.
Baton Rouge, LA 70804-9214
Phone: (800) 259-5300
or 5301 / (504) 342-5900

Maine Bureau of Insurance
Department of Professional and Financial Regulation
Bureau of Insurance #34 State House Station
Augusta, Maine 04333-0034
Phone: (207) 624-8475
Fax: (207) 624-8599

Maryland Insurance Administration
501 St. Paul Place
Baltimore, Maryland 21202-2272
Phone: (410) 333-6300
or 1-800-492-6116
Michigan Insurance Bureau
Mailing address
For US Postal Service mail, use this address:
Michigan Insurance Bureau
P.O. Box 30220
Lansing, MI 48909-7720
Delivery (street) address
For overnight services, UPS, or freight deliveries, use this address:
Michigan Insurance Bureau
611 W. Ottawa
Lansing, MI 48933
Receptionist: (517) 373-9273
General Information (Recorded Menu) (517) 373-0220
Licensing – Agents/Agencies (Recorded Menu) (517) 373-0234
Fax: (517) 335-4978

Minnesota Insurance Division of the Department of Commerce
133 East Seventh St.
St. Paul, MN 55101
Phone: (612)297-7161

Mississippi Insurance Department
P.O. Box 79
Jackson, MS 39205
Phone: (601) 359-3569
Fax – (601) 359-2474

Missouri Department of Insurance
P.O. Box 690
Jefferson City, MO 65102-0690
(573) 751-4126

Nebraska Department Of Insurance
Terminal Building
941 “O” Street, Suite 400
Lincoln, NE 68508-3690
Phone: (402) 471-2201
TDD: (800) 833-7352
Voice: (800) 833-0920

Nevada Department of Business & Industry Division of Insurance
Carson City/Reno
1665 Hot Springs Road, Suite 152
Carson City, Nevada 89706-0646
Phone: (702) 687-4270
Fax: (702) 687-3937
Las Vegas
2501 East Sahara Avenue, Suite 302
Las Vegas, Nevada 89158
Phone: (702) 486-4009
Fax: (702) 486-4007
E-Mail: Department Mailbox

New Hampshire Department of Insurance
Carol Beaudoin, License Supervisor
NH Insurance Department
169 Manchester Street, Concord, New Hampshire 03301
Phone: 271-2261 Fax: 271-7029

New Jersey Division of Insurance
20 West State Street
P.O. Box 325
Trenton, N.J. 08625-0325
Telephone: (609) 292-5360

New York State Insurance Department
New York City
25 Beaver Street
New York, NY 10004
Phone: (212) 480-6400

North Carolina Department of Insurance
P.O. Box 26387
Raleigh, NC 27611
Phone: (919) 733-7343
Fax (919) 733-6495

Ohio Department of Insurance
2100 Stella Ct.
Columbus, OH 43215-1067
Phone: 1-800 686-1526

Oklahoma Department of Insurance
3814 North Santa Fe
P.O. Box 53408
Oklahoma City, OK 73152
OKLAHOMA CITY AREA (405)-521-2828
In State Toll Free (800)-522-0071
Fax Phone Number (405)-521-6652

Oregon State Insurance Division
Phone: (503) 947-7984
E-Mail: Insurance Division

Pennsylvania Insurance Department
1326 Strawberry Square
Harrisburg, PA 17120
Phone: (717) 787-2317

Rhode Island Department of Business Regulation
233 Richmond Street
Providence, Rhode Island 02903
Phone: (401) 277-2246
FAX: (401) 277-6098
TDD: (401) 277-2223

South Carolina Department of Insurance
P.O. Box 100105
Columbia, South Carolina 29202-3105
Phone: (803) 737-6095
Fax: (803) 737-6232

South Dakota Division of Insurance
118 W Capitol
Pierre, SD 57501
Phone: (605) 773-3563
Fax: (605) 773-5369

Tennessee Insurance Division
500 James Robertson Parkway
Nashville, Tennessee 37243-0574
Phone: (615) 741-2693

Texas Department of Insurance
333 Guadalupe
Austin, Texas 78701
E-Mail: Elton Bomer
Phone: (512) 322-3503
Fax: (512) 322-4380

Utah Department of Insurance
3110 State Office Bldg.
PO Box 146901
Salt Lake City, Utah 84114-6901
Phone: (801) 538-3800
Fax: (801) 538-3829
TTY: (801) 538-3826

Vermont Division of Insurance
89 Main St (City Center)
Drawer 20
Montpelier VT 05620-3101
Phone: (802) 828-3303
Fax: (802) 828-3306

Washington State Insurance Commissioner
P.O. Box 40255
Olympia, WA 98504-0255
E-Mail: Kacy Brandeberry
Phone: (306) 407-0341
Fax: (306) 438-7629

West Virginia Board of Risk & Insurance Management
4501 MacCorkle Ave. SW
300 Ghannam Bldg.
South Charleston, WV 25309
Phone (304) 766-2646
Fax (304) 766-2653
toll free inside WV 1-800-345-4669

State of Wisconsin Office of the Commissioner of Insurance
121 East Wilson Street
Madison, Wisconsin 53702
Phone: (608) 266-3585
Madison: (800) 236-8517
Statewide: (800) 947-3529
(TDD) (ask for 608-266-3586)
Fax: (608) 266-9935

Wyoming Insurance Department
122 W. 25th Street
3rd Floor East
Cheyenne, WY
82002-0440
Phone: (307) 777-7401

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