How to File a Health Insurance Complaint

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How to File a Health Insurance Complaint

If you feel your health insurance company or agent has acted illegally or improperly there is a simple process to file a health insurance complaint:

  1. First and foremost, keep detailed records of all relevant documents. Write down all conversations you have had with your agent / company. Keep all written correspondences in one folder. Save copies of canceled checks, bank statements, or paystubs with payments to the health insurance company. Find and read through your policy agreement.
  2. Contact your health insurance company's customer service department. Explain your complaint and give them a reasonable amount of time to address the issue.

    3. If you still don’t feel that the issue has been resolved, you can elevate the dispute:

  3. Consider your legal options. If the dollar amount in dispute is large, consider contacting an attorney to explain your problem and get their advice. Usually getting a referral from a friend is the best way to find an attorney. If this doesn't work, you can try using an online lawyer database. For smaller dollar amounts, you may want to file a small claims suit. The dollar limit for small claims are set on a state by state basis.
  4. Contact your state insurance commissioner. Almost all state commissioners have health insurance complaint forms on their websites (see State Insurance Sites for a list of state insurance departments). After filling out the form and submitting it, someone from your state will likely contact you to ask a few follow-up questions and may ask for supporting documents. Next, the state insurance department will contact your health insurance company to discuss the issue. Afterwards, they will either contact you to tell you that they are closing their investigation, or they will transfer you to a specialist in the insurance department to continue working on resolving the issue.
  5. Contact the Better Business Bureau and file a health insurance complaint with them as well. Health insurance companies work hard to resolve complaints because they hurt sales. Many people check with the BBB before buying insurance.

    6. If all fails, you still can warn others about the practices of your company/agent:

  6. Share your experience on consumer opinion websites such as consumeraffairs.com. I would name the health insurance company in the complaint, but not give the url of the health insurance website. Recent news articles have claimed that even links from complaint websites can help build web traffic to the referenced website.