Question:
What happens when you file a complaint with the Department of Insurance against your

health carrier?    — CINDY D. (posted on July 18, 2003)

July 18, 2003
First you will want to make sure you have a "fully insured" health insurance plan. Fully insured plans are governed for the most part by state and federal legislation. If the insurance company is not following legislative guidelines, etc. they can be fined. On the other hand, if you have an ASO plan also known as an "Employer Self Funded" plan (these are generally large corporations) the department of insurance will have little or no say in what's going on as it is your employer who has the say in what's covered and/or not covered. In self funded plans, the insurance company acts as a third party administrator in that they process the claims and pay the claims with the employer's funds. If you have an ASO plan, your best bet is to complain to your corporate headquarters. I used to work for a large insurance company in their Corporate office. We responded to DOI (Department of Insurance) complaints daily. If you have a more specific question, feel free to email me.
   — Kamy

July 18, 2003
If you are unlucky enough to have a self-funded plan (ERISA plan), you are, quite frankly, screwed. I have this and there's basically nothing the DOI (Department of Insurance) can do for you based on the law. I was told that there "were a lot of laws that weren't enforced" and that I should "get real." I am suing in small claims court because no attorney will take an ERISA claim because the law only allows them to pay what they would have paid and nothing else for pain and suffering and no attorney wants to work for nothing. It's a tragedy. I have informed my husband to look for another job that does not have a self-insured plan.
   — sandieguy