Joint Insurance Committee

Margie Howe and Mark Bailes represent the NCSCSW on the Joint Insurance Committee.  The Joint Insurance Committee is a collaborative policy/advocacy committee that has representatives from each of the independent practitioner groups (listed in order of joining): the NC Psychiatric Association, the NC Psychological Association, the NCSCSW, The NC- National Association of Social Workers and the NC Advance Practice Nurses of the Nurses Association.  Each group is represented by at least two clinicians.  The Joint Insurance Committee meets monthly to discuss issues pertaining to managed care, insurance policy, changes in representative insurances, the State Health Plan, and other issues pertaining to reimbursement for consumers and practitioners.  The Committee has been influential in establishing consensus among practitioner groups and lobbying for mental health benefits for consumers and practitioner since the 1980's.

MESSAGE FROM THE NORTH CAROLINA DEPARTMENT OF INSURANCE

The North Carolina Department of Insurance Healthcare Review Program requests that you forward to your employees the following information about an important consumer service known as External Review. Thank you.

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Have you or someone you know had medical services denied by your health insurance company? If so, your Department of Insurance may be able to help you. The Department of Insurance offers a service called “External Review.” External Review is a service to help you if your health insurance company denies coverage for services on the grounds that they are not medically necessary. How can this benefit you?

professional registered nurses provide consumer counseling with the appeals and grievance process, and explain how to request an external review

external review is completely free to you

an expert medical professional who has no association with your health insurance company performs the medical review

if the expert medical professional determines that the denial was wrong, your insurance company will be required to pay for the service

since July 1, 2002, consumers have received $1.2 million in services thanks to external review

For more information about External Review Services, or if you have questions about the appeal process with your insurance company, contact the Department’s Healthcare Review Program by calling (919) 715–1163 or toll-free in North Carolina at (877) 855-0231. You may also stop by the Department to make your inquiries at:

North Carolina Department of Insurance

Healthcare Review Program

Dobbs building

430 N. Salisbury St., Room 4105

Raleigh, NC 27603

Or visit the Department’s web site at: http://www.ncdoi.com/Consumer/ERP/ExternalReview.asp