Bureau of Insurance, State Corporation Commission-Licenses all health insurance companies, HMOs, and health services plans. The Consumer Services Section, Life and Health Division, assists Virginia consumers in resolving disputes with insurance companies, HMOs, health services plans, and the agents who may sell such insurance programs in Virginia. The bureau will also provide addresses and telephone numbers of insurance companies that are licensed to sell insurance in Virginia. www. state.va.us/scc
State Corporation Commission, Bureau of Insurance Life and Health Division, Consumer Services Section P.O. Box 1157 Richmond, VA 23218 Toll Free: 1-800-552-7945 Office of the Managed Care Ombudsman Toll Free 1-877-310-6560
Social Security Administration-Provides regional offices across Virginia. You may receive answers needed by phone or locate office nearest you. www.ssa.gov
Social Security Administration To receive a copy of the 718 E. Franklin Street MEDICARE HANDBOOK, call: Richmond, VA 23219 1-800-444-4606 Toll Free: 1-800-772-1213
Virginia Association of Health Plans-Represents Virginia's Managed Care Health Plans. Publishes the Directory of Virginia Health Maintenance Organizations, which includes profiles of Virginia HMOs. www.vahp.org
Virginia Association of Health Plans 118 North Eighth Street Richmond, VA 23219 Phone: 1-804-648-8466
Virginia Department for the Aging-Responsible for providing programs for those age 60 and older under the federal older Americans Act. Provides counseling advocacy services under the Virginia Insurance Counseling and Advocacy Project.
Virginia Department for the Aging 1600 Forest Avenue, Suite 102 Richmond, VA 23229 *In Richmond: 662-9333 (VTDD) *Toll Free 1-800-552-3402 (VTDD)
Virginia Department of Health/Center for Quality Health Care Services and Consumer Protection-Charged with regulating the quality of health care services provided by managed care health insurance plans in Virginia. Consumers with concerns about access to care and the health services delivered by managed care insurance plans can address their concerns with the Center. In July 2000, managed care health insurance plans will be required to maintain a Certificate of Quality Assurance issued by the Department of Health. www.vdh.state.va.us/quality/index.htm
Virginia Department of Health/Center for Quality Health Care Services and Consumer Protection, Complaint Unit 3600 West Broad Street, Suite 216 Richmond, VA 23230-4920 Toll Free: 1-800-955-1819
Virginia Medicaid/DMAS-Administers Medicaid program for Virginia. www.state.va.us/~dmas
Virginia Department of Medical Assistance Services 600 East Broad Street, Suite 1300 Richmond, VA 23219 In Richmond: 786-7933 Toll Free: 1-800-552-8627
Maryland Insurance Administration-Licenses all insurers and agents; is involved in any activity necessary for regulation of insurance. Performs financial examinations, issues/revokes licenses, approves rates/forms; conducts hearings and investigations. Complaints and Investigation Unit/Life and Health Unit assists consumers in resolving disputes with health insurance companies. gacc.com/mia
Maryland Insurance Administration Complaints and Investigation Unit/Life and Health 525 St. Paul Place Baltimore, MD 21202 Toll Free: 1-800-492-6116
Social Security Administration-Provides regional offices across Maryland. You may get answers you need by phone or locate office nearest you. www.ssa.gov
Social Security Administration 6401 Security Boulevard Baltimore, MD 21235 Phone: 1-410-965-8882 Toll Free: 1-800-772-1213
Health Care Access & Cost Commission-Develops and carries out new health care policies including development of a comprehensive standard health benefit plan and quality and performance measures for HMOs. Publishes consumer HMO guide. www.hcacc.state.md.us
Health Care Access & Cost Commission 4201 Patterson Avenue, 5th floor Baltimore, MD 21215 Phone: 1-410-764-3460 Toll Free: 1-877-245-1762
Health Choice and Maryland Children's Health Program-Health Choice is Maryland's statewide Managed Care Program for low-income citizens. Maryland Children's Health Program provides health insurance coverage for average to low-income children and pregnant women. dhmh.state.md.us
Health Choice Maryland Department of Health and Mental Hygiene 201 West Preston Street, Room L Baltimore, MD 21201
Medicaid Assistance-Provides health benefits for low-income people. Eligibility established through each local department of social services. dhmh.state.md.us
Medicaid/Maryland Department of Health and Mental Hygiene 201 West Preston Street Baltimore, MD 21201-2399 In State Only/Toll Free: 1-800-685-5861 Phone: 1-410-767-6500 Public Information: 1-410-767-6860
Maryland Department of Aging-Oversees programs, services, and benefits delivered through 19 local Area Agencies on Aging. Provides services directly to older persons or contracts with other agencies to administer programs. For more complete information on program availability and options, call your local Senior Information and Assistance Office or the number below to locate your office.
Maryland Department of Aging 301 West Preston Street, Suite 1007 Baltimore, MD 21201 *Toll Free: 1-800-AGE-DIAL (1-800-243-3425) In Maryland Only *Phone: 1-410-767-1100
North Carolina Department of Insurance-Consumer Services Division responds to questions and complaints concerning insurance; acquaints consumers with alternatives and courses of action that a citizen can pursue to solve a particular insurance problem. www.ncdoi.com
North Carolina Department of Insurance P.O. Box 26387 Raleigh, NC 27611 Phone: 1-919-733-7343 Toll Free: 1-800-JIM-LONG (1-800-546-5664)
North Carolina Association of Health Plans-A nonprofit trade association of health plans providing health care benefits; works to promote awareness/acceptance/growth of health plans in North Carolina. www.ncahp.org
N.C. Association of Health Plans, Inc. 5 West Hargett Street, Suite 310 Raleigh, NC 27601 Phone: 1-919-833-3470
North Carolina Division of Aging-Provides system of services, opportunities, protective supports. Seniors' Health Insurance Information Program (SHIIP) provides information on Medicare, Medicare supplemental insurance, and long-term care insurance; provides assistance/ counseling with health insurance problems.
North Carolina Division of Aging Caller Box 29531 Raleigh, NC 27626-0531 *Phone: 1-919-733-3983 Seniors' Health Insurance Information Program *In State Only/Toll Free: 1-800-443-9354
North Carolina Division of Medical Assistance-Manages Health Check (Medicaid) program and NC Health Choice for Children (to age 18).
North Carolina Division of Medical Assistance P.O. Box 29529 Raleigh, NC 27626-0529 Phone: 1-919-857-4011 In State Only/NC Family Health Resource Line: 1-800-367-2229
State of Tennessee/Department of Commerce & Insurance-Licenses health insurance companies and HMOs. Two consumer offices; one specifically to assist the elderly with health insurance/long term care (see below). The Consumer Services Office investigates consumer complaints concerning claims, agents, and companies.
Consumer Services Office 500 James Robertson Parkway, 4th Floor Nashville, Tennessee 37243-1135 Phone: 1-615-741-2218 In State Only Toll Free: 1-800-342-4029 or Insurance Assistance Office for the Elderly In Nashville: 741-4955 *Toll Free: 1-800-525-2816
Tennessee Association of Health Maintenance Organizations- Association representing 18 Tennessee HMOs. www.tahmo.org
Tennessee Association of Health Maintenance Organizations 3200 West End Ave, Suite 500 Nashville, TN 37203 Phone: 1-615-783-1668
TennCare Bureau-Services are offered through managed care organizations (MCOs) and behavioral health organizations (BHOs); is open to Medicaid-eligible or persons not insurable as determined by an insurance company's denial (for medical reasons) of health insurance.
TennCare Bureau 729 Church Street Nashville, TN 37247-6501 Phone: 1-615-741-0213 TennCare Information Line in Nashville: 741-4800 In State Only/Toll Free: 1-800-669-1851
Department of Consumer and Regulatory Affairs, Business Regulation Administration-Ensures health, safety and economic welfare of D.C. residents through licensing, inspection, compliance and enforcement.
Insurance Department 810 1st Street NE, Suite 701 Washington, DC 20002 Phone: 1-202-727-8000
Social Security Administration-Provides regional offices in D.C. Receive answers by phone or locate office nearest you. www.ssa.gov
Social Security Administration 2100 M Street, NW Washington, DC 20001 Phone: 1-215-597-4100 Toll Free: 1-800-772-1213
District of Columbia Office on Aging-Agencies provide information, assistance, outreach to seniors through network of programs. ci.washington.dc.us/aging/aghome.htm
District of Columbia Office on Aging One Judiciary Square 441 Fourth Street, NW Suite 900-South Washington, DC 20001 *Phone: 1-202-724-5626
Medicaid-Medicaid managed care plans; DC Healthy Families, a health insurance program for children and low-income families.
DC Medicaid Managed Care Help 122 C Street, NW Washington, DC 20001 Phone: 1-202-783-2118 1-202-698-4350 DC Medicaid 645 H Street, NE Washington, DC 20002 1-202-698-4350 DC Healthy Families 33 N Street, NE Washington, DC 20002 1-800-MOM-BABY (1-800-666-2229)
West Virginia Insurance Commission-Protects interests of policyholders in insurance matters; regulates all domestic and foreign insurance companies doing business in the state. Consumer Services serves as liaison between insurance industry and consumers not represented by attorneys. Consumer Advocacy serves public interest, regulates quality assurance for licensed HMOs. www.state.wv.us/insurance
West Virginia Insurance Commission Consumer Services Division P.O. Box 50540 Charleston, WV 25305-0540 Phone: 1-304-558-3386 Consumer Advocate P.O. Box 50540 Charleston, WV 25305-0540 Phone: 1-304-558-3864 *In State Only Toll Free: 1-800-642-9004
West Virginia Bureau of Senior Services-Provides programs for senior citizens. West Virginia Senior Health Insurance Network (SHINE) provides health insurance counseling for Medicare beneficiaries.
Bureau of Senior Services Holly Grove State Capitol 1900 Kanawha Blvd, East Charleston, WV 25305 *Phone: 1-304-558-3317 West Virginia Senior Health Insurance Network (WVSHINE) Toll Free: 1-877-WV-SHINE (1-877-987-4463)
Bureau of Medical Services-Provides access to appropriate health care for Medicaid-eligible individuals; administers Children's Health Insurance Program and Medicaid Managed Care Program.
www.wvdhhr.org/bms Bureau of Medical Services State Capital Complex Building #6 Charleston, WV 25305 Phone: 1-304-926-1700 www.wvdhhr.org/Pages/wvchip Bureau of Medical Services W. VA. Children's Health Insurance Program 1900 Kanawha Boulevard East, Building 6 Charleston, WV 25305-9926 Department of Health and Human Resources Client Services: In State Only/Toll Free: 1-800-642-8589 Family Matters Hotline: 1-888-WV-FAMILY (1-888-983-2645) or P.O. Box 1831 Clarksburg WV 26301 www.wvdhhr.org/bms/medmcare.htm Bureau of Medical Services Medicaid Managed Care Toll Free: 1-800-449-8466
Tricare-A program of health care coverages managed by the Department of Defense for active duty military personnel, their families, military retirees, and their dependents. Tricare blends the military's direct care system, managed care providers, and the original Champus program. The Tricare regional information phone and World Wide Web listings below indicate the states and areas covered by that listing.
Mid-Atlantic Region Virginia (except Northern Virginia) North Carolina 1-800-931-9501 www.tma.med.navy.mil or anthemalliance.com Northeast Region Northern Virginia District of Columbia Northeast Corner of West Virginia Maryland 1-888-999-5195 www.sierramilitary.com or tricare.detrick.army.mil/ne Gulf South Region Tennessee 1-800-444-5445 General Information 1-800-403-3950 Claims www.humana-military.com Heartland Region West Virginia (except Northeast) 1-800-941-4501 dodr5www.wpafb.af.mil or anthemalliance.com
Agency for Health Care Policy Research-An arm of the U.S. Department of Health and Human Services (AHCPR). Develops practical, science-based information for medical practitioners, consumers, and other health care purchasers. www.ahcpr.gov
Agency for Health Care Policy & Research P.O. Box 8547 Silver Spring, MD 20907-8547 Toll Free: 1-800-358-9295
National Association of Health Underwriters-A trade association of agents, brokers, and consultants of insurance. www.nahu.org
National Association of Health Underwriters 2000 N. 14th Street, Suite 450 Arlington, VA 22201 Phone: 1-703-276-0220
National Committee for Quality Assurance-Since 1991, the NCQA has evaluated more than half of the nation's managed care programs in terms of patient records, complaints, equipment, and personnel. NCQA may grant accreditation for three years, for one year, or provisionally, or may deny accreditation. NCQA uses HEDIS, to measure plan quality. www.ncqa.org
National Committee for Quality Assurance (NCQA) 2000 L Street, NW, Suite 500 Washington, DC 20036 Phone: 1-202-955-3500
Patient Advocate Foundation; National Patient Advocate Foundation-Provides educational materials to consumers on managed care; operates National Legal Services Network; works for health care reform.
The National Patient Advocate Foundation 780 Pilot House Drive, Suite 100-C Newport News, VA 23606 Toll Free: 1-800-532-5274 Phone: 1-757-873-6668
Social Security Administration-Provides regional and local offices. You may receive answers you need by phone or call to locate office nearest you.
1-800-772-1213