Complaint to your state insurance department
Tell the state agency that regulates insurance companies what your insurer did, what you already did, and what you ask the agency to do.
- Private: nothing leaves this tab
- A template, not legal advice
This one is for a specific kind of coverage
It is written for the coverage tagged above. If you have a different kind (for example Medicare or Medicaid instead of a job-based or individual plan), it may cite the wrong rules. Check what kind of coverage you have and use the letter written for it.
When to use this, and what it is not
When to use this. When your coverage is a policy sold by an insurance company and you believe the insurer broke a rule or ignored your appeal. A complaint does NOT stop an appeal deadline: keep every appeal and external review deadline running while you complain. If your employer pays claims itself (a self-funded plan), the state insurance department usually cannot help, so use the Department of Labor help request instead.
This is a template, not legal advice. Read it, change anything that is not true for you, and send it only when you are satisfied. Your notice and your plan document control.
Fill in the letter
Your letter
[Your name] [Your address]
13 November 2026
[Name and address of your state insurance department's consumer complaints office]
Re: Complaint to your state insurance department Plan: [Name of the health plan] Member ID: [Member ID] Claim or reference number: [Claim or reference number]
To whom it may concern:
I am filing a complaint about [Name of the health plan], my health insurer. My member identification (ID) number is [Member ID] and my claim number is [Claim or reference number].
The plan denied [The care or drug that was denied] on [Date on the denial notice]. The care was provided or requested on [Date of the care] by [Doctor, hospital or pharmacy].
What the plan did: [What the plan did]
What I have already done: [What you already did, with dates]
I know this complaint does not replace my appeal, and I am keeping my appeal and external review deadlines. I am writing because I believe the insurer did not follow the rules that apply to it. I have enclosed copies of the notices, my appeal and my record of calls and letters, so that you can see the dates.
I ask the department to: 1. Review whether the insurer followed the law and its own policy in handling this claim. 2. Ask the insurer to respond to the specific problem I describe above. 3. Tell me in writing what you find, or tell me if another agency is the right one. 4. Tell me what, if anything, I should send you.
Enclosures: 1. Copy of the denial notices 2. Copy of your appeal letter, with proof of the date you sent it 3. Your Explanation of Benefits, if you have one 4. Your log of calls and letters
Sincerely, [Your name]
Before you send it
Find your state insurance department's complaint page or phone number on your state page on this site, or on your denial notice if it names the department. Ask whether you can file online, by mail or by phone, and ask for a complaint reference number. Keep a copy and proof of the date.
What to enclose
- Copy of the denial notices
- Copy of your appeal letter, with proof of the date you sent it
- Your Explanation of Benefits, if you have one
- Your log of calls and letters
What happens next
- Keep every deadline. A complaint does not stop the appeal clock. For most job-based and individual plans you have at least 180 days after receiving a denial notice to appeal, and at least four months after a final denial to request external review. A grandfathered individual policy may give less. Check the date on your notice, which controls.
- Ask the department how long it expects to take, and write down the answer.
- Your state may have a Consumer Assistance Program that can help you file an appeal. HealthCare.gov directs people to it.
- If the problem is a surprise bill, use the No Surprises Act complaint letter as well.
- If the department says it cannot help because your employer pays claims itself, send the Department of Labor help request.
- If you are writing for someone else, tick "I am writing for someone else". The office you are writing to may require its own authorization form. See the letter "Name someone to act for you".