How to Deal With Unsatisfactory Health Care

Getting the best care and services means understanding how your health plan works, what your rights are, and how to complain if you are not satisfied with the level of care or customer service provided by the health insurance company or the physicians. You are entitled to receive copies of test results as well as medical information about yourself or immediate family members. If you are in a managed care plan, you can ask to change your primary care doctor if you are unhappy with the relationship. You may also be able to switch to a different health plan with the same insurance company or seek new coverage through a different insurance company.

Most medical insurance plans have an appeals process that both you and your doctor may use if you disagree with the plan's decisions on authorizations for treatments or claims payments. If your plan refuses to provide or pay for services, you can complain or file a grievance about any decision you feel is unfair or you can go through the appeal process. Your differences may often be resolved during the appeal process and it is the first step before seeking legal actions.

Be sure to keep written records of all correspondence with the health insurance company customer service and claims department. Also make sure you have copies of all claims forms and copies of medical bills. You may also wish to keep a record of all phone conversations, including the date and time, the people you speak with, and the nature of each call.

If you are still not satisfied, or you wish to take outside actions, check with your State Department of Insurance for advice on the best way to proceed further with your complaints.