07/19/2016

Psychiatrists and patients are encouraged to file complaints with ODI about insurance companies

Increasingly, the OPPA is hearing from patients with private insurance who are unable to get an appointment with a psychiatrist even though there may be many psychiatrists identified on the carrier's in-network provider directory. These patients - in fact anyone (including psychiatrists) - can file a complaint with the Ohio Department of Insurance (ODI) so the matter can be reviewed.

The OPPA is very concerned about network adequacy and has met again recently with representatives of the Ohio Department of Insurance in an effort to ensure that individuals in Ohio who suffer with mental illness and/or an addiction disorder have access to treatment when needed as provided by their insurance company.

Network Adequacy is a measurement of a health plan's ability to meet the medical needs of the plan purchasers by providing sufficient providers in each area (geographic and medical areas) to ensure that patients have access in a reasonable amount of time without having to travel unreasonable distances.  

Even though Ohio passed a law related to network transparency, the information provided in the provider directories may still not be accurate for several different reasons, including one that is quite common:

• Many of the psychiatrists listed in the directory may be inpatient psychiatrists who do not provide any outpatient care. This gives the impression that there are many more psychiatrists participating in the plan than is actually the case.

The Consumer Services Division of the Ohio Department of Insurance provides consumer information and investigates complaints involving insurance companies and agents. Regrettably, it seems that no one is complaining to ODI about not being able to access a psychiatrist for treatment. We hope that OPPA members will begin filing complaints and encourage their patients to file a complaint (especially when a patient has indicated they had to wait a long time for an appointment or had difficulty finding a psychiatrist in their plan).

Click here for important information on How to File a Consumer Complaint.

To file a complaint about an insurance company or agent, click here for the Consumer Complaint Form.

To obtain a hard copy of the Consumer Complaint Form, please call the Ohio Department of Insurance Consumer Services Division at 1-800-686-1526.

Should you or your patient(s) have any further questions, please contact a Consumer Services analyst at 1-800-686-1526.

Be sure to let the OPPA know you filed a complaint so that we can follow-up with ODI.  Simply send an e-mail to oppa@ohiopsychiatry.org letting us know who the insurance company is and the general nature of your complaint.