If you’d like to make a complaint or file an appeal about a claim that was denied, call customer service at the number on the back of your member ID card. If you are unable to resolve your complaint, you can file an appeal. Start by downloading the complaint/appeal form for your health plan. Forms are available at the bottom of this page.
If you aren’t satisfied with the result of your complaint or appeal, you can request an independent review. See how to request a review
If you have a complaint about our privacy practices or feel that we have not complied with the terms of our Notice of Privacy Practices, you have the right to file a complaint. You can download the form below.
Choose the complaint form for your health plan. If you’re not sure which form to use, call the number on the back of your member ID card.
If you are unhappy with a decision we’ve made about your complaint or appeal, please ask customer service for an explanation by calling the number listed on the back of your member ID card. If your complaint or appeal is about a health care claim, you can ask an independent organization to review it.
To ask for a review, send a written request to the state commissioner along with a $25 filing fee. The Center for Health Dispute Resolution will work with you and your health plan to review your claim.
They may waive the $25 fee in cases of financial hardship. You can also choose someone to act on your behalf, but you must ask for this in writing.
If you have questions about reviews, contact one of the following offices below:
You might have a self-insured plan if your health plan is from your employer. State independent review guidelines do not apply to some self-insured plans. To find out if you have a self-insured plan, you can ask your employer or call the number on the back of your member ID card. After you have completed our complaint and appeal process, you can review a copy of your health plan for any more appeal options.
Don’t have a copy of your health plan? Call customer service at the number on the back of your member ID card to ask for a copy.