File a Complaint
The State Corporation Commission’s Bureau of Insurance (the Bureau) assists thousands
of consumers each year by responding to inquiries and complaints. You may: (1) file
a complaint about services you receive from your insurance company or agent; (2)
request our assistance in appealing a denial by your Managed Care Health Insurance
Plan (MCHIP); or (3) request an independent external review for eligible adverse
determinations by your health insurer. We encourage you to first review the suggestions
provided in the informational questions below; you may be able to successfully resolve
your issue without the formal complaint process.
File a Complaint
Appeal Denial by a Managed Care Health
Insurance Plan
Request an Independent External
Review of a denied health insurance claim
Below is information to assist you in resolving your issue and gathering information
and documentation needed. Please review:
Are You Experiencing a Problem with Your Insurance
Company or Agent?
Is Your Problem Still Unresolved After Contacting
Your Insurance Company or Agent?
What Can Consumer Services Do?
What Can Consumer Services Not Do?
What Are Some Types of Plans the Bureau does not
Regulate?
What Are My Rights?
How Do I File a Complaint?
How Soon Should I Expect a Response from the Bureau
of Insurance?
What Contact will be made with the Insurance Agent
or Company?
How Long Will the Investigation Take?
Should I call to check on the Investigation’s Progress?
Are You Experiencing a Problem with Your Insurance Company or Agent?
The Bureau encourages consumers to try to resolve any problem with their company,
plan or agent before contacting the Consumer Services Section. Many times a mistake
has been made, and is easy to correct upon inquiry.
Always keep a photocopy of your letter for your records. Keep copies of all e-mail
or fax communications as well.
If you decide to file your complaint by telephone with your company or agent, keep
a written record of:
- The date and time of your call,
- The name of the person you talked to, and
- What was said during the call
Is Your Problem Still Unresolved After Contacting Your Insurance
Company or Agent?
You may file a complaint with the BOI as described below under How Do
I File A Complaint, or you may call us first to discuss your concerns. A
Consumer Services Representative will be able to address many of your questions
or provide assistance that may help you in resolving your complaint. If we cannot
assist you by telephone, we will advise you on how to file a complaint.
What Can Consumer Services Do?
- Thoroughly investigate your complaint.
- Help you get a clear response to your questions.
- Cut through red tape.
- Correct misunderstandings.
What Can Consumer Services Not Do?
- Recommend a particular company, agent, or product.
- Recommend or rate an insurance company.
- Provide legal services that are sometimes required to settle complicated problems.
- Make medical decisions or require an insurer to pay for services it has determined
were not "medically necessary."
- Identify an insurance company with whom a particular person may have a policy.
- Dispute an underwriting decision made in accordance with an insurer’s underwriting
guidelines.
- Resolve a dispute that is a question of fact.
- Require an insurer to pay a claim.
If we are not able to resolve your problem, we will tell you why. If the insurance
law and facts are on your side, we will try to see that your rights are protected
and that your complaint is resolved in a satisfactory manner.
What Are Some Types of Plans the Bureau does not Regulate?
What Are My Rights?
Insurance Companies:
- are not allowed to unfairly discriminate as to premium rates charged or kinds of
coverage,
- are required to pay claims promptly and fairly, and
- must give the consumer access to certain information collected by the insurance
company.
How Do I File a Complaint?
How Soon Should I Expect a Response from the Bureau of Insurance?
Within a week after we receive your written complaint, we will assign a file number
and send you a letter acknowledging receipt of your complaint.
What Contact will be made with the Insurance Agent or Company?
In most cases, a letter and a copy of your complaint will be sent to the company
or agent, requesting an explanation of its position. Telephone contact may be made
to discuss the complaint, to ask questions, or to make specific requests. After
the company or agent responds, we will determine what further actions, if any, we
will take.
How Long Will the Investigation Take?
Normally, it takes about 45 days after we receive a complaint to provide our written
response. However, it may take longer if your complaint is claim related, or involves
a unique or complex problem, or requires the insurer or agent to conduct extensive
research.
Should I call to check on the Investigation’s Progress?
You do not need to call. We will keep you informed and advise you of the outcome
of our review.
If you have additional information, send it to us in writing. (Include the file
number we assigned in our letter of acknowledgment, and send it to the person investigating
your complaint.)