How to File a Complaint Against Your Insurance Company

When your insurer violates your rights or refuses to follow the law, filing a regulatory complaint can be more powerful than an appeal. Learn where and how to file.

Where to File

State Insurance Department

  • For individual, small group, and fully-insured employer plans
  • Investigates violations of state insurance law
  • Can take enforcement action against insurers
  • Find yours at: naic.org/state_web_map

Department of Labor (DOL)

  • For ERISA self-insured employer plans
  • Investigates violations of ERISA requirements
  • File at: askebsa.dol.gov

Centers for Medicare & Medicaid Services (CMS)

  • For Medicare plans and marketplace plans
  • 1-800-MEDICARE reporting line
  • For ACA marketplace complaints: healthcare.gov

What to Include in Your Complaint

  1. Your name and policy information
  2. Specific violation description
  3. Dates of denial and appeal attempts
  4. Copies of denial letters and appeal correspondence
  5. Explanation of how the insurer violated the law
  6. Requested resolution

When to File

  • After exhausting internal appeals (recommended but not always required)
  • When the insurer violates appeal timelines
  • When you suspect parity violations or discrimination
  • When the insurer refuses to provide required information

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Frequently Asked Questions

Will filing a complaint affect my coverage?

No, it is illegal for an insurer to retaliate against you for filing a complaint. Federal and state laws protect your right to file complaints and appeals without penalty.

How long does a state insurance complaint take?

Most state insurance departments respond within 30-60 days. Complex investigations may take longer. The insurer is typically required to respond to the department within a set timeframe.

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