My claim was denied
How do I complain to my state insurance department?
Photo: Lucas Guimarães Bueno / Pexels
Every state has an insurance department that takes complaints about the plans it regulates. Most let you file online, by mail or by phone. Send your letters and a short timeline; the department asks the plan to respond.
What to do
- Check who regulates your plan. Your Evidence of Coverage or your employer's benefits office can tell you.
- Gather the denial letters, your appeal, the plan's replies, and the dates of each call.
- Write a short timeline, one sentence per event, and say what you want: a claim paid, a deadline kept, or a rule explained.
- File on the department's complaint page, keep the complaint number, and follow up if you hear nothing.
What to say
I'd like to file a complaint about my health plan. Can you tell me whether your department regulates this plan and what documents to include?
Call the department's consumer help line first if you are not sure which agency covers your plan.
What to watch out for
This is a sensitive stepSmall details here can change the outcome, and some mistakes are hard to undo. We highly recommend a free 15-minute call with us before you decide.
Filing with the state when your employer self-funds the plan. State insurance laws generally don't cover those plans; the US Department of Labor does, at 1-866-444-3272.
Better done together
We’re here to help
A complaint works best when it is short, clear and has the right papers attached. We help you put it together and decide when a complaint, an appeal or both make sense.
Every situation is different, and these are sensitive moments, so we look at yours with care. We often see what others miss, and we never take commissions from insurance companies: the only thing we are working for is what is right for you.
Free · 15 minutes · No pressure
The rule behind it
States regulate health insurance, and each has an insurance department (in some states called the insurance commissioner or department of financial services). Plans you buy yourself or get through a fully insured employer are usually state-regulated. Self-funded employer plans fall under a federal law called ERISA and the US Department of Labor. Medicare plan complaints go to Medicare or the plan, and Medicaid has its own state process.
Sources
- NAIC — How to file a complaint
- US Department of Labor — Technical Release 2014-01 (self-insured plans and state law)
- US Department of Labor — Ask EBSA
- Medicare.gov — Filing a complaint
- Your plan's Evidence of Coverage
Amanda Alcodia
Education, not medical, legal or insurance advice.
Useful next steps
Start with the free Kit. If your situation needs a person, the intro call is free too.