Mike Causey
Guest Commentary
Almost everyone, at some point, has a question about insurance. They may not understand their Explanation of Benefits on a health insurance claim. They may have a question about their insurance bill, or they may be going back and forth with their insurance company over a claim.
Fortunately, the Department has a whole team of experts whose mission is to help answer your insurance questions. The Department’s Consumer Services Division will answer your calls at our toll-free number, (855) 408-1212, from 8 a.m. to 5 p.m. Monday through Friday.
Before you call, you may want to check out a wealth of insurance information on our website, www.ncdoi.gov.
After navigating to our website, click on the “Consumers” tab. There you’ll find information about all kinds of insurance – automobile, homeowners, life, health and an array of more specialized insurance types.
Scroll down and you can click on a link to assist you in filing a complaint. Or, you can click on the “Consumer Publications” link which will allow you to download consumer guides to different kinds of insurance.
There are certain things that we can and cannot do. Our consumer experts can:
— Help you understand your insurance policy.
— Forward a copy of your complaint to your insurance company and require the company to provide a response or an explanation.
— Review the response by the company. We can make sure the company is complying with state laws and regulations. In addition, we can make sure the company is following the stipulations detailed in your insurance policy.
— Suggest courses of action to take to resolve your problem if we do not have the authority to resolve it. That may include referring you to another government or consumer agency. Or we may recommend that you seek the advice of an attorney.
— Provide help with an appeal or external review through the Department’s Smart NC Division if your health insurance company denies a procedure or medicine that your
doctor believes is medically necessary. Our Smart NC Division can be reached at the same toll-free number.
Our consumer experts cannot:
— Act as your lawyer.
— Intervene in a pending lawsuit on your behalf.
— Consult with you if you are represented by an attorney unless your attorney gives us written permission.
— Decide who was negligent or at fault in an accident.
—Determine the value of a claim or the amount of money owed to you.
— Decide the facts surrounding a claim or establish who is telling the truth involving a claim.
— Address issues that are not subject to the state’s insurance laws or are governed by other state agencies.
We try to respond promptly, clearly and courteously to your insurance questions and complaints.
Mike Causey is the North Carolina Insurance Commissioner.