If you have an issue with your insurance company, putting your side of the story in writing in the form of a grievance letter can be an effective way to address the problem. A letter allows you to spell out the specifics of your concern, reference pertinent information and create a paper trail.
Know Your Rights
Go through your policy handbook and read up on your rights as a policy holder. Look for sections that pertain to your grievance so you can reference them in your letter. If your letter is addressing the company’s unwillingness to pay a claim they say is not covered, find proof to support your argument in the handbook. For example, “Although you denied the claim filed for routine annual blood testing, on page 13, section C of the handbook, it clearly states in paragraph two that routine annual blood tests are a covered benefit of this policy. I am attaching a photocopy of this section for your reference.”
Be specific about everything you put in writing. If you spoke with a company representative who was rude and unhelpful, don’t just write a general complaint that says employees are rude -- go into detail. For example, “I called your customer service line on January 5, 2015 and spoke with Wanda Smith about claim #12345. When I disputed the bill, which did not reflect my deductible, Wanda said I was stupid and I should just keep my mouth shut and pay the amount due. I found this to be unprofessional behavior that poorly represented the image your company tries to promote.”
Stick to Guidelines
All insurance companies have different processes for filing grievances. You may be able to find them in your policy manual, on the company’s website or by calling the organization’s customer service phone number. For best results, follow submission guidelines to the letter to ensure your correspondence gets to the right department and is addressed in a timely manner. Include your name and policy number on all documents, use reference or claim numbers were appropriate and always send copies -- keep original documents with you.
Any time you’re dealing with an insurance company, keep records of all correspondence, phone conversations and paperwork that pertains to your case. For example, estimates for car or home repair, medical records and appraisal reports for valuable merchandise. Also keep a log that details when you send and receive letters and the names and extensions of the people you speak to. When you write grievance letters, you’ll be able to use all of your data to support your case, attaching copies of pertinent paperwork as needed.
Make it Easy
Clearly state what you hope to achieve with your letter and make it easy for the insurance company to comply. For example, “I would like for you to contact my doctor’s office at the following number and correct the billing error outlined in my preceding correspondence." If there is a deadline for making an appeal, stick to it. Send your letter by certified mail to ensure it arrives. If you get no response or are unable to resolve your issue with your letter, contact your state insurance commissioner.
- Washington State Office for the Insurance Commissioner: How to Appeal a Health Insurance Denial
- Washington State Office for the Insurance Commissioner: Keeping Track of Communication
- USA.gov: Sample Consumer Complaint Letter
- Einsurance: How to File a Complaint About an Insurance Company
- National Association of Insurance Commissioners: Map of NAIC States & Jurisdictions
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