Insurance Company complaints
A denial, delay, billing error, or network problem with your health plan.
Best for
- • Claim denials
- • Prior authorization delays
- • Surprise bills
- • Network adequacy
Step by step
Follow these in order — skipping a step is the most common reason a complaint stalls.
- 1File the plan's internal grievance or appeal first — external routes usually require it.
- 2Reference your member ID, claim number, dates of service, and the denial code.
- 3Request the clinical criteria used and the reviewer's credentials.
- 4If denied, request an independent external review within the deadline stated in the letter.
- 5File in parallel with your state insurance department (fully insured plans) or the U.S. Department of Labor (most employer self-funded plans).
Internal appeals: 30 days for pre-service, 60 days for post-service. Expedited/urgent: 72 hours. External review: usually 45 days, or 72 hours if expedited.
Avoid these mistakes
- Ask your clinician for a letter of medical necessity that quotes the plan's own criteria back to it.
- Never miss the deadline in the denial letter — it is usually 180 days.
- Keep a call log: date, time, representative name, reference number.
External review → state insurance commissioner → DOL EBSA (self-funded) → state attorney general.
Educational purposes only
Phoenix Health Compass does not provide legal advice or medical advice. This content summarizes publicly available government and nonprofit resources and is cited throughout. Always confirm requirements, deadlines, and forms with the official agency.
Last reviewed by the Phoenix Health Compass editorial team.