Resolve a Problem
Things aren’t guaranteed to go right with insurance and when things don’t happen the way you expect them to, it’s important to know who can help. It’s important to first speak with the member services department for your insurance company. Even if you disagree with them, it’s important to listen to what they are saying and write down their reasons for a denial or unpaid bill. Once you have this information, feel free to call one of our navigators at (877) 570-3642 to have them explain it to you.
The Affordable Care Act also requires all insurance companies allow you to appeal decisions they make. You have up to six months to appeal decisions. There are two kinds of appeals you can file: internal and external. The Health Insurance Marketplace has an easy to understand article here outlining the differences, timelines, and what you’ll need:
Appeals can be challenging, but worthwhile if you have evidence supporting your view that the denial was incorrectly handled within the rules for your insurance plan. Here are two more resources when thinking through an appeal:
A Patient’s Guide to Navigating the Insurance Appeals Process
10 Tips for Appealing a Denied Health Insurance Claim
Another helpful resource is the Pennsylvania Insurance Department. They can help resolve disputes between consumers and insurance companies.
Pennsylvania Insurance Department
Tax Filing and Healthcare
Healthcare now affects everyone’s taxes. Whether you have employer sponsored coverage, a Marketplace plan, Medicaid, Medicare, or are uninsured, you need to understand the basics of how your coverage status affects your taxes. A good step is to look at our tax flowchart below:
- 1095-A: If you bought insurance on the Health Insurance Marketplace, you’ll receive this form in the mail. It details the premiums you paid and any financial assistance you received. If you did not receive a form or think it’s incorrect, call the Marketplace at (800) 318-2596.
- 1095-B: You may receive this form from your health insurer detailing who was covered and for how long. If it’s wrong, contact your insurer directly using the member services number on the back of your insurance card.
- 1095-C: You may receive this form from your employer detailing offers of health coverage available to you and who in your family could be covered by these offers. This form will usually only be sent by employers with 50 or more employees. If you think it’s wrong, contact your HR department. If you received one of these forms and you were enrolled in a Marketplace plan, contact a navigator immediately at (877) 570-3642.
So what’s my next step? It’s important to review the new tax forms you receive in the mail. You’ll receive these every year (just like your W2) and you’ll want to make sure they are correct.