Health Insurance

How to File a Complaint About Your Health Insurance

 

You can file a complaint against your health plan if you disagree with how a health care service was covered or denied, if you feel you had poor customer service or the company misrepresented what a policy covers, or you think the company broke a state or federal insurance law.

Self-Funded Plans Regulated by Federal Government

Most Texans get their insurance through self-funded plans that are regulated by the U.S. Department of Labor’s Employee Benefits Security Administration.

  • If you have a self-funded plan from an employer that is a government or church, then you should follow the complaint procedures in your benefits booklet and other plan documents.
  • If you have a self-funded plan from a private-sector employer or union, then file your complaint with the Dallas Regional Office of the U.S. Department of Labor’s Employee Benefits Security Administration:

525 South Griffin St, Room 900
Dallas, Texas 75202

Plans Regulated by Texas Department of Insurance

Texans with health plans that are not “self-funded” have plans that are regulated by the Texas Department of Insurance (TDI). TDI’s consumer protection division can help resolve your complaints. TDI will contact your company for a response to the complaint and will decide if your issue was handled within the terms of the policy. TDI will take action against your health plan if it finds that state insurance laws were broken.

  • You can file your complaint and upload supporting documents using TDI’s Online Complaint Portal.
  • Visit TDI’s website for more info about the complaint process and how TDI’s consumer protection division can help you.
  • Call TDI’s Consumer Help Line at 1-800-252-3439 if you have questions or need help filing a complaint.

Before You File a Complaint:

Call your insurance company first. You may be able to resolve your issue by calling your health plan. Most health plans will have a toll-free helpline printed on your policy. When you call your health plan, have your policy number and your claim number if you’ve already filed a claim. Follow up in writing by describing your complaint and how you want it resolved. Send copies (not originals) of any supporting documents and ask the company for a written response.

Have your info ready. When you call TDI or the U.S. Department of Labor to file a complaint, have your policy number and the name of your health plan ready. Also be prepared to provide copies of both sides of your insurance card and copies of any letters between you and the health plan, medical bills, advertising materials, or other supporting documents.