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Originally Posted by ScottSinger
Don't states have a State Insurance Agency or Commisioner that investigated stuff like this?
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Yes. State Insurance Administration. All they can do is validate if your health insurance company filed the claim correctly. That's about it.
It wouldnt hurt to file a complaint just as an inquiry but most likely the insurance company did things by the book. Usually they dont get results in favor of consumers unless the complaint is about the way the diagnosis was coded into the system. The nurse or/and insurance rep could've coded the treatment incorrectly or diagnosis incorrectly and that caused the bill to be higher. Now you're then treading on some potential legal action ground.
Now adays with EMR it's almost impossible to code a procedure wrong and transmit it to the insurance company. The insurance company also has their own due diligence as well to validate the claim.
You'd probably only want to contact them if you were diagnosed for cancer but received treatment for rabies and billed 900K or something like that.
They are worthless and only serve as just a way of getting a formal explanation from the insurance company as "why" things were done the way they were.