Monday, January 27, 2014

What to do if you haven’t received your proof of medical insurance

Some Washington health-care enrollees have not yet received proof of their insurance coverage. As a result, many consumers are unsure if their medical treatments are covered. If you recently bought a plan, but still haven’t received proof of insurance from your insurance company, Insurance Commissioner Mike Kreidler offers these tips.

Since open enrollment began on Oct. 1, insurance companies have encountered multiple problems that have prevented them from being able to enter new members into their systems. Some companies received incomplete or incorrect information from the insurance marketplaces. Other companies were overwhelmed with the number of applications they received and were unable to process them by the time the new plans went into effect. This delay in providing proof of coverage has many consumers worrying if they really have insurance and wondering what to do next.

Contact the company
The first thing you should do is contact your insurance company to verify that you do have insurance coverage. Ask your company for proof of coverage, such as an insurance card or identification numbers. When you speak to your company, take detailed notes of the conversation. Include the date and time that the conversation took place, and the name of the representative you speak to. Keep copies of any written communication you receive, such as emails or letters. You may need these materials later.

If you are not sure how to contact your plan, our website has contact information for each of the insurance companies that sells plans through Washington Healthplanfinder.

You should also verify that you have paid your first premium on time. Some insurers have permitted late payments for coverage retroactive to Jan. 1. Find out your insurer’s deadline and keep any records that can serve as proof of payment.

If you are about to buy coverage from Washington Healthplanfinder, print any paperwork or confirmations that you receive during the enrollment process.

If you know you don’t qualify for a subsidy through Washington Healthplanfinder, you may find it easier to buy insurance directly a broker or an insurance company. Here’s a list of the plans that are available in Washington.

Remember, 2014 open enrollment for most plans ends on March 31.

Payment options
You may need to get a prescription filled or see your doctor before you receive your insurance card. Your medical provider (hospital, doctor, pharmacy) may be able to verify your coverage by contacting your insurer directly. If they cannot verify your coverage cannot be obtained, you still have options.

One option is to pay for expenses out of pocket. Once your insurance coverage is established, your insurance company should reimburse you in accordance with its established fees for services, minus any deductibles and copayments you are responsible for.

You may also be able to work with your doctor’s office, hospital or pharmacy to delay payment or set up a payment plan until they can verify that you’re insured. Keep your receipts and any bank statements that show that you’ve paid for the services.

More information
The Insurance Commissioner doesn’t administer Washington Healthplanfinder, so if you purchased insurance there, your best bet is to contact their customer service staff if you have questions about whether you are covered.