Insured, But No Proof
What to Do If You Haven’t Received Your Proof of Insurance Coverage
Complications within health insurance marketplaces have created challenges for some new enrollees who 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 purchased a plan, but still haven’t received proof of insurance from your insurance company, the National Association of Insurance Commissioners (NAIC) offers these tips.
Since open enrollment began on October 1, insurance companies have encountered multiple problems that have prevented the companies 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 insurance company for proof of coverage, such as an insurance card or identification numbers. When you speak to your insurance company, take detailed notes of the conversation. Include the date and time that the conversation took place, and the name of the representative. Hold on to copies of any written communication you received from your insurance company such as emails or letters as you may need these materials later.
You should also verify that you have paid your first premium on time. Some insurers have permitted late payments for coverage that is retroactively effective to January 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 your state’s marketplace, print out any paperwork or confirmations that you receive during the enrollment process.
Payment Options
You may need to get a prescription filled or see your doctor before you receive your insurance card. Your provider (hospital, doctor, pharmacy) may be able to verify your coverage by contacting your insurer directly. If verification of 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 to the extent that the service or medication is covered under your policy. 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.
Your State Insurance Department Can Help
If you are still having difficulty obtaining proof of coverage from your insurance company, reach out to your state insurance department for assistance. You can find your department’s contact information here.
More Information
If you have questions about the health insurance marketplace in your state, contact your state insurance department. For more information on the NAIC’s activity on health care reform, visit the Healthcare Reform Special Section. You can also find more information on the ACA on the Department of Health and Human Services website.
About the National Association of Insurance Commissioners
As part of our state-based system of insurance regulation in the United States, the National Association of Insurance Commissioners (NAIC) provides expertise, data, and analysis for insurance commissioners to effectively regulate the industry and protect consumers. The U.S. standard-setting organization is governed by the chief insurance regulators from the 50 states, the District of Columbia and five U.S. territories. Through the NAIC, state insurance regulators establish standards and best practices, conduct peer reviews, and coordinate regulatory oversight. NAIC staff supports these efforts and represents the collective views of state regulators domestically and internationally.