When employees have trouble getting claims paid, getting new insurance cards, or just don't like their doctors, you can bet you'll be the first one they'll tell. About the only thing you can do to help them is to become an advocate on their behalf with the insurance company, which can become enormously time consuming.
What should you do when an employee has a complaint? Unless you want all your employees coming to you with their insurance problems, you should instruct them to contact the insurance company directly. Most insurance companies have a member services department that is designed to help employees with complaints and problems. Always encourage your employee to make member services their first stop.
When they call, advise them to have:
Also encourage your employees to put in writing to the company any problems they are having if they are not resolved by member services or by your customer service representative or agent.
If, after speaking with the member services people, the problem still exists, you can try mentioning it to your service representative or agent, if you have one. If all else fails and the problem warrants serious action, your employees can contact the state Department of Insurance to file a complaint.
As the employer, you can attempt to assist your employees, but don't get
caught in the middle. Recognize when the employees' problems and concerns are
valid and take steps to assist them when possible. If, however, an employee
demands coverage for a treatment that is clearly not specified in the policy or
if the employee did not follow the rules for obtaining coverage under an HMO,
for instance, there is little you will be able to do.