State agency ยท Texas Department of Insurance
Texas Department of Insurance: appeal, external review and complaints
The Texas Department of Insurance explains how to appeal a denied treatment, ask for an independent external review and file a complaint. It helps with fully insured plans and cannot overturn a reviewer's decision.
Know before you go
The page gives no deadline for the appeal; your denial notice and plan booklet say how and by when to ask. It says the department can help if your card shows TDI or DOI, and that it does not regulate Medicare, Medicaid, military plans or most government employee plans. The department's own pages describe external review in different ways, so ask the Help Line which route your plan uses.
- Cost
- External reviews are free to you, according to the page.
- Where
- Texas
- How to start
- Appeal to your plan first. Then ask the plan for an external review, and call the Help Line if you get stuck. You can file a complaint with the department if your card shows TDI or DOI.
- Phone
- 800-252-3439, as printed on the provider's page
- Have ready
- Your insurance card; Your denial notice; Your plan booklet; Your doctor's letter
Where this comes from
- Provider
- Texas Department of Insurance
- Source we read
- https://www.tdi.texas.gov/consumer/complaint-health.html
- Date we read it
- . This is not a fresh check.
- Date the provider printed
- 2025-12-17
- What we checked
- We read the provider's public page. We have not verified availability, eligibility or outcomes for any individual.
Other starting points
- Program or service
Beneficiary and Family Centered Care Quality Improvement Organizations: find yours
The Medicare contractors that handle fast appeals when hospital or other care is ending too soon, and complaints about the quality of care. Each state is assigned to one of two organizations.
From Centers for Medicare & Medicaid Services
- Program or service
California Department of Managed Health Care: Independent Medical Review
California's regulator for managed care plans reviews denials of medical services, emergency payment and experimental treatment through Independent Medical Review. One form starts either a review or a consumer complaint.
From California Department of Managed Health Care
- Program or service
Center for Medicare Advocacy self-help materials
Downloadable self-help toolkits for Medicare denials involving home health care, outpatient therapy and skilled nursing facility care, from a nonprofit law organization. The page describes materials, not a helpline.
From Center for Medicare Advocacy