The State Corporation Commission’s Bureau of Insurance has recovered more than $3.4 million worth of benefits and savings so far this year through complaint investigations, managed care appeals and market conduct examinations, according to a news release.
Two of the bureau’s divisions — Life and Health and Property and Casualty — recovered the money for Virginia consumers, which came in the form of refunds, insurance benefits, interest payments, reimbursements, additional claims payments and reinstated coverage.
So far this year, those two divisions handled more than 8,400 inquiries, 2,300 formal consumer complaints and 63 appeals of adverse decisions from health plans.
The bureau has specially trained staff who can help Virginians with claims issues. They will sometimes appeal a complaint for a consumer and overturn a decision based on the health plan’s policies or Virginia’s coverage regulations.
“Our team is trained to help consumers with their insurance questions and investigate any complaints they may have with their insurance provider,” said Virginia Insurance Commissioner Scott White in a statement. “We can look into whether a company has acted in accordance with its policy and the law.”
There are limits to what the bureau can do, however. Those covered by self-insured plans — meaning a company that may use a health plan as a third-party administrator but pays all its own claims — can receive advice from the Bureau of Insurance, but the state cannot address problems with coverage.
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