Tips to Help You with Your Managed Care Health Insurance Plan

• Read thoroughly and understand your plan documents. 

• Know how your managed care plan works before you need to use it.

• Ask questions about anything that is not clear, confusing, or that you do not understand. 

• If you need assistance, reach out to the managed care plan’s representatives, or contact the Office of the Managed Care Ombudsman.

• If a problem arises, contact the managed care plan’s customer service or grievance and appeal departments. 

• Know your appeal rights if you experience an adverse decision, to include preauthorization requests and claim denials.

• Be concise and use facts to support your appeal request.  Use your physician as your asset, to provide supporting letters and clinical documentation.

• Be mindful of the timeframes to file an appeal and keep copies of documentation sent to the managed care plan.

• Contact the Office of the Managed Care Ombudsman for assistance, at any point of the appeal process. 

Office of the Managed Care Ombudsman
Bureau of Insurance
P.O. Box 1157
Richmond, Virginia 23218
ombudsman@scc.virginia.gov
1-877-310-6560, Option 3