PROVIDER COMPLAINTS — HOW WE CAN HELP We can investigate complaints that fall within our regulatory authority. We Can Investigate: Billing Disputes Out-of-Network level benefits paid for emergency services Benefits paid for non-emergency services from an out of network provider Claim-handling delays Claim denials Overpayment recovery by an insurer Questionable sales/marketing Conflicting information from an insurer Other health insurance-related disputes We Cannot: Resolve or investigate complaints regarding self-funded or self-insured employee health benefits plans (also known as self-funded ERISA plans) as they are outside the division’s authority. Give legal advice, act as lawyer or claims adjuster, or interfere in a pending lawsuit Resolve a complaint if the only evidence is your word against the word of others Address issues we can’t legally enforce Ready to File? Please utilize all appeal rights available under the health insurance contract for your patient. In general, Division of Insurance does not become involved until after the contractual rights of appeal have been exhausted. Gather supporting documentation to support your complaint such as: A duplicate of the claim appeal packet that was submitted to the insurer. A copy of the response from the insurer to the claim appeal / other claim documentation. A copy of the assignment of payment. If the complaint involves several bills, an assignment of payment for each bill or power of attorney is required. After reviewing the information above, you are ready to file a provider complaint. Along with your supporting documentation, please submit a completed Provider Complaint Form, one for each patient. Please note, the provider complaint form/process is to be completed by medical providers and is not appropriate if you wish to complain about a physician. (This form is also available at the division office or by contacting us at consumerservices@alaska.gov or 907-269-7900 with questions). Provider Resources Understanding the Requirements for Health Care Providers and Facilities under the No Surprises Act Contact Consumer Services Email Call 907-269-7900 or 1-800-INSURAK in-state, outside Anchorage Fax 907-907-269-7910 If Your Issue Falls Outside Our Regulatory Authority If your issue falls outside our regulatory authority, you may have additional appeal, complaint, or legal recourse available to you. You can discuss these options with the Division at (907) 269-7900 or directly with the patients’ health plan. The Consumer Organizations lists many consumer protection agencies, organizations and resources.