Consumer Complaints Toolkit: Health Insurance

Resources for Health Advocates, Health Providers and Enrollment Assisters

Consumers can file complaints with state agencies such as the Department of Insurance (DOI) and Attorney General's Office (AG) to resolve problems they are having with health insurance plans, including discrimination, denial of payment for care, compliance with state and federal rules about health coverage, and surprise medical bills. Problems with insurance companies disproportionately impact the most vulnerable consumers including people of color, those for whom English is a second language, people with mental illness and substance use disorders, and people with low-income. Without support, these consumers are also the least likely to file a successful complaint. This toolkit provides information to help health advocates, health care providers, and Navigators and other enrollment assisters accomplish three things: 1) understand the consumer complaints process, 2) help consumers file complaints with relevant state agencies, and 3) engage in state-based advocacy to improve the complaints process.