If a patient has been denied services due
an exclusion on the medical policy, or due to not meeting the medical
necessity criteria, will the department on insurance hear the case to
insure that the decision is appropriate? If so, how do we contact the
Department of Insurance in VA?
Answer:
I don't know if the Virginia Bureau of Insurance will "hear a case" per se, but they do take action to ensure that insurers are acting properly. It's certainly worth the effort to contact them and get their opinion on tthis situation.
Your best bet is likely the office of teh Ombudsman. If there is something wrong with the action this insurance company has taken, you will need the Ombudsman to work on your behalf.
You can call the BIO Ombudsman and Consumer Service Hotline at 877-310-6560. This number is toll-free nationwide.
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