The health insurance industry is fraught with instances of fraud. Sometimes, consumers commit white collar fraud against the insurance companies. Other times, it’s the insurance companies committing fraud against the consumers. For example, imagine you receive a $20,000 hernia surgery, and suddenly you find out that your insurance company is only going to pay for half of it, but this goes against your agreement.
In Minnesota, the Department of Commerce is in charge of regulating the insurance industry. It makes sure that insurance companies are operating in an above-board manner that doesn’t seek to take advantage of consumers.
In this respect, if you have a problem with your insurance company, it will likely be the Department of Commerce that investigates your complaint, and if it deems your complaint to be valid, it will investigate the matter on your behalf and try to resolve it.
Let’s say your health insurance denies your claim. You can appeal the matter. First, you’ll want to ask your insurer for information about why it denied the claim. Then you’ll get the response from your insurer. Next, if you’re not satisfied, you might be able to ask for an external review. This is when the Department of Commerce will get involved to decide if your insurer was justified to deny your claim. Your insurance company must follow the Department of Commerce’s decision.
You’ll still have the right to appeal the determination of the Department of Commerce in court if you’re not satisfied. During this process, you’ll probably want to use the services of a consumer fraud attorney that assists Minnesota residents in these kinds insurance company disputes.
Source: Minnesota Department of Commerce, “Health Insurance,” accessed June 23, 2017
