OPA Insurance Committee
The OPA Insurance Committee addresses issues that OPA members have with insurers. The Committee works with OPA Central Office staff to respond to individual complaints about the practices of insurance companies, tracks patterns of abuse and assures that appropriate regulatory agencies are made aware of these patterns.
Insurance Problems? Here’s What You Can Do
Many of us have traveled the painful and annoying road of dealing with insurance personnel in order to resolve problems with claims. Sharing information, empowering our membership and using the leverage of our organization are some of the goals of the OPA Insurance Committee.
When addressing issues with insurance companies, there are several tools available to OPA members:
- Share information about your experience on OPA’s listserv. This will stimulate discussion and may generate solutions to your problem as well as provide ideas to other members.
- File a detailed complaint to the insurance company of your unresolved problem. Download that form here. Be sure to document all your efforts and create a paper trail. By filing an appeal, you are formally documenting your issue and pave the way for the filing of a formal complaint with the Ohio Department of Insurance.
- Contact OPA’s Insurance Committee. The committee is developing a process whereby it will be able to monitor complaint that are being pursued with an insurer as well as those complaints that are filed with the Department of Insurance. When possible, the committee will assist you in your efforts.
- For unresolved issues with an Insurance Company, contact the Ohio Department of Insurance (ODI). Download the provider complaint form here.The Department of Insurance wants to hear from psychologists about problems with insurers. They report receiving few formal complaints from psychologists. The Department has jurisdiction over companies that are regulated by the state of Ohio. Some self-insured companies do not have to follow Ohio law because of the ERISA exemption. (After the federal parity law goes into effect on Jan. 10, 2010, there will be fewer exemptions for self-insured companies regarding mental health coverage.)
How to File a Complaint for Prompt Pay or Credentialing Online
Credentialing and Contract Complaint Form
Consumer Complaint Form
Complaint Form to Send to Insurance Companies
Provider Complaint Form/Prompt Pay Complaint Form to Send to ODI
The Ohio legislature, with help from OPA’s advocacy efforts, gave the Department of Insurance the right to enforce complaints against insurers in two areas:
- Prompt Pay Complaints (requires insurers to pay clean claims in 30 days or pay interest). Read the FAQs on the Prompt Pay Law for more information.
- Credentialing and Contract Complaints (House Bill 125) requires quick credentialing, transparent contracts, no-changes in mid-term of contract without agreement by psychologist and more. Read the Mental Health Toolkit from the department for more information.
Please send copies of your filed complaints to OPA, so that we can document the problems. Remember, we want to work with you. Advocacy and member support are primary goals of the Insurance Committee and OPA.
Other Key Functions of the Insurance Committee
- works with the advocacy chair to prioritize legislation on insurance issues and meets with key legislators to discuss OPA member problems.
- meets with key administrators at insurers doing business in Ohio to discuss concerns.
- gathers research to document our concerns. See results of the OPA Insurance Survey.
- liaisons between OPA and state and federal agencies, boards, commissions and regulatory bodies and addresses those involved with Medicare and Medicaid.
Contact the Central Office or above listed Committee Chair if you are interested in participating with this group.