Complaints · US · Health insurance
How to complain about a health insurance company (US)
File an internal appeal with your health insurer within 180 days (6 months) of the denial notice; your state's Consumer Assistance Program can file it for you. If the insurer still says no, ask for an external review within 4 months of the final denial. Standard reviews are decided within 45 days and the insurer must accept the result. Your state insurance department also takes complaints.
Complaint routes and time limits checked against official sources on .
First
Complain to the insurer
in writing
Wait
See below
or a final response
Then
External review
Checked
27 Sep 2026
official sources
1. Complain to the insurer first
File an internal appeal with your insurer using its forms, or write with your name, claim number and insurance ID. Your state's Consumer Assistance Program can file it for you. Include: name, claim number and insurance ID number; the Explanation of Benefits or denial letter; why the care should be covered; a letter from your doctor; what you want: the claim paid or coverage restored.
2. How long to wait
File the internal appeal within 180 days (6 months) of the denial notice. If the insurer still says no, ask for an external review within 4 months of that final denial. Urgent cases can run both at once.
3. Escalate to External review
Within 4 months of the insurer's final denial. It can: an independent decision the insurer must accept by law; standard reviews decided within 45 days; urgent ones within 72 hours. healthcare.gov/appeal-insurance-company-decision/external-review
4. Escalate to State insurance department
Set by each state. It is free. content.naic.org/state-insurance-departments
Where to escalate and the time limits
Time limits run from the date shown in each row. Keep the final response or deadlock letter, because the ombudsman will ask for it.
| Who | Time limit | Cost |
|---|---|---|
| External review | Within 4 months of the insurer's final denial. | Check their website |
| State insurance department | Set by each state. | Free |
Evidence to keep
Explanation of Benefits forms and denial letters. Your internal appeal request and what you sent with it. Doctor's letters and medical records. Notes of calls: date, time, name and title.
Also worth knowing
Keep your originals and send copies.
Guides and definitions
- How to file a CFPB complaint, what happens next and does it work (Guide)
- Regulation E (Regulation E is the US federal rule that limits your liability for unauthorized debit card and electronic transfers to $50 or $500 if you report them in time.)
Complaints about something else
- Bank or credit card (US)
- Loans and credit reports (US)
- Phone, internet and cable (US)
- Airlines (US)
- Utilities (power, gas, water) (US)
- Shopping and online retailers (US)
- Landlord or housing (US)
All complaint guides · Get your route with dates and a letter
Common questions
How long do I have to appeal a health insurance denial?
180 days, about 6 months, from the notice that your claim was denied. If your health situation is urgent, you can ask for an external review at the same time as the internal appeal.
What is an external review?
An independent third party looks at your insurer's decision, so the insurer no longer has the final say. You must ask within 4 months of the final denial. A final denial dated October 31, 2026 gives you until February 28, 2027.
How long does an external review take?
A standard external review is decided no later than 45 days after the request. An expedited review for urgent cases is decided within 72 hours or less. Your insurer is required by law to accept the reviewer's decision.
Can I complain to my state about my health insurer?
Yes. Your state insurance department takes complaints about insurance companies and agents, and many let you file online, by mail or by phone. The NAIC's directory links to every state department and its complaint page.
What papers do I need for a health insurance appeal?
Explanation of Benefits forms and denial letters, a copy of your internal appeal request and everything you sent with it, letters from your doctor, and notes of every call with the date, time, name and title of the person you spoke to. Keep originals and send copies.
Sources and assumptions
- General routes from official sources; a scheme may ask for more before it takes your case.
Guidance on where to complain, not legal advice.