Author: Mike Causey, Insurance Commissioner
Insurance can be confusing. You may have a question about a charge on your insurance bill. You may wonder what is covered and what isn’t covered by a policy. Perhaps something is confusing on an Explanation of Benefits notice from a health insurance claim.
The Department of Insurance has a team of experts dedicated to helping you with your insurance questions. Just call the Department’s Consumer Services Division at (855) 408-1212 weekdays from 8 a.m. to 5 p.m.
Before calling, check out our website at www.ncdoi.gov. Click on the “Consumers” tab. There, you’ll find a wealth of information about all kinds of insurance – automobile, homeowners’, life, health and a number of more specialized types of insurance.
Scroll down and you can click on a link to assist you in filing a complaint. Or you can find a link to consumer publications on all kinds of insurance products or look up information about an insurance company or agent.
There are certain things that we can and cannot do. Our consumer experts can:
- Help you understand your insurance policy.
- Forward a copy of your complaint to your insurance company and require the company to provide a response or an explanation.
- Review the response by the company. We can make sure the company is complying with state laws and regulations. In addition, we can make sure the company is following the stipulations detailed in your insurance policy.
- Suggest courses of action to take to resolve your problem if we do not have the authority to resolve it. That may include referring you to another government or consumer agency. Or we may recommend that you seek the advice of an attorney.
- Provide help with an appeal or external review through the Department’s Smart NC Division if your health insurance company denies a procedure or medicine that your doctor believes is medically necessary. Our Smart NC Division can be reached at the same toll-free number.
Our consumer experts cannot:
- Act as your lawyer.
- Intervene in a pending lawsuit on your behalf.
- Consult with you if you are represented by an attorney unless your attorney gives us written permission.
- Decide who was negligent or at fault in an accident.
- Determine the value of a claim or the amount of money owed to you.
- Decide the facts surrounding a claim or establish who is telling the truth involving a claim.
- Address issues that are not subject to the state’s insurance laws or are governed by other state agencies.
Last year, our consumer team helped policyholders facing hurdles with their insurance companies receive $25.9 million. Our SmartNC team helped North Carolinians originally denied medical procedures or prescription drugs receive $1.9 million in medical services, medical devices or prescription drugs.
Our consumer specialists try to respond promptly, clearly and courteously to your insurance questions and complaints.