One type of plan is a standard indemnity policy, which gives people freedom to visit a health care provider of their choice and pay out of pocket for their treatment. The insurance plan reimburses members for some portion of the cost. The other common plan is a managed care plan. Under this plan, medically necessary care is provided in the most cost effective—or least expensive—way available. Plan members must visit health care providers chosen by the managed care plan. Generally, a co-payment is charged to the patient, but sometimes all care received from providers within the plan is covered.
All health insurance companies have internal grievance and complaints procedures. If you have a complaint, follow the company's procedures. All states have a state health insurance commissioner. Contact the office of your state government to see what external grievance and complaint procedures may exist in your state.