Last Updated: May 2, 2016
Grievances and Complaints
Most people will never have a problem with their health insurance. But when you do have a complaint with your plan, it can be difficult to understand the steps you must take to resolve your problem.
It is important to remember that not all health plans are subject to the appeal process. If your plan is self-funded by your employer, then it is subject to federal, not state law. Public programs like Medicare and Medicaid also have their own processes. Make sure you are aware of what kind of health insurance plan you have before you begin the grievance process. For further information, see the Consumer's Guide to Health Insurance Grievances and Complaints or the Fact Sheet on Filing a Complaint About Health Plans.
Consumers are also provided an opportunity to resolve some coverage disputes through an independent review organization that has no connection to their health plan. See the
Independent Review Process for more information.
If you have questions or concerns about your insurance company or agent, write to the insurance company or agent involved. Keep a copy of the letter you write. If you do not receive satisfactory answers, you may contact the Office of the Commissioner of Insurance to file a complaint.