Impact Prior Auth Debate By Filing An 'Official' Complaint
Last Updated: Mar 15, 2018
Prior authorization made national news when the California Insurance Commissioner announced he would investigate a former Aetna medical director’s admission that he never looked at patients' records when deciding whether to approve or deny care.
Are similar unfair prior auth practices happening in Pennsylvania?
Physicians and their practices have the power to protect their patients and reverse prior auth abuses from insurance companies. When physicians believe an unfair prior auth denial has occurred, they should file an official complaint with the Pennsylvania Insurance Department.
Here are three steps to file your complaint:
- Go to the Pennsylvania Department of Insurance Complaint web page.
- On that page, you’ll find a 2-page complaint form to fill out.
- Mail or fax it back to the address on the page.
Please note: the Pennsylvania Department of Insurance does not have jurisdiction over, and therefore cannot investigate, self-insured plans as a result of the Employee Retirement Income Security Act of 1974 (ERISA). The Pennsylvania Department of Insurance can investigate complaints from most other insurance plans.
The Pennsylvania Department of Insurance takes these complaints seriously.