Common health insurance issues facing Arkansas consumers:
- Denials of claims due to pre-existing conditions, non-covered services or services considered not medically necessary.
- Premium increase questions.
- Insurers who fail to process or pay claims.
- Difficulty negotiating the internal or external appeals processes when a claim is denied.
- Questions regarding limited benefit plans and other non-traditional health plans.
Complaints involving health insurance issues should be directed to the Consumer Services Division of the Arkansas Insurance Department, or secondarily, the Attorney General’s office. The Insurance Department may be reached at (501) 371-2640 or (800) 852-5494 or at Insurance.Arkansas.gov.
Before you file a complaint:
- Know your policy’s guidelines for coverage.
- Follow the appeal procedures available through your insurance plan if you believe a payment decision is in error.
- Report insurers who fail to respond to properly submitted claims for payment.
Keep copies of Explanations of Benefits and related correspondence.
Health Discount Programs
“Affordable Health Care Plan”
“Pre-existing conditions? No problem!”
“No Deductible or Co-pays”
“Thousands of providers in our PPO network”
“Discounts up to 60 percent”
When claims like these pop up in the media, it may sound like health insurance. Chances are, however, it is not. Most of the time, the pitches are for a medical discount program. Medical discount plans can be useful for consumers looking to save money on health care. But, consumers need to be aware that they are not the same as health insurance. These plans do not pay any of your health care costs. Instead, they require you to pay a fee for a list of health care providers and sellers of health-related products who are willing to offer discounts to members of the program. Many medical discount programs claim to provide big discounts from hundreds of providers for a wide range of services — from doctor visits and dental exams to hospital stays and prescription drugs — but fail to make good on those claims.
Check it out
When considering your health insurance options, know what you are getting — medical insurance or a medical discount plan. If you are not sure, check with the Arkansas Insurance Department to see if the company offering the plan is registered to sell insurance. If the company is not registered to sell health insurance, consider shopping elsewhere. Remember that if you buy a health insurance plan, it generally covers a broad array of services and pays you or your health care provider for your medical bills.
In contrast, medical discount programs offer “discounts” on some services, products or procedures. If you are interested in joining a medical discount program, you should investigate the details before you pay any money. For example:
- Look for a phone number or website of the company you are considering doing business with so you can get more information.
- Before you pay any money, ask the company for a list of providers who participate in the program. Call the providers and ask about the services and discounts they are offering.
- If the program does not provide a list of providers for you to review before you buy, consider taking your business elsewhere.
- Investigate the details of any program carefully. Read the fine print, paying special attention to the refund policy. If a program does not readily provide information before you buy, it is not likely to be responsive after you have paid.
- If your usual medical or dental providers do not participate, see whether other doctors in your area participate in the program and will give you the discount the plan promoters promise.
- Do the math. Try to calculate what your total payment for a discount program will be for a given amount of time. You could be responsible for paying a substantial amount up front, in addition to monthly fees and other costs. The costs of the program may total more than the savings you anticipate.
- Arkansas law offers numerous protections for consumers who purchase a health discount plan. Among other things, consumers have the right to a full refund within 30 days of purchase. The card must also prominently display that the product is not insurance.