How to File a Consumer Insurance Complaint
A step-by-step guide from the Mental Health Insurance Reform Task Force · buildbetterhealth.org
Your claim was denied, delayed, or clawed back
Document everything
Get the denial in writing. Note dates, reference numbers, and contact names. Gather clinical documentation and your Explanation of Benefits (EOB).
File an internal appeal with your insurer
You have the right to appeal. Submit clinical notes, a letter of medical necessity, and any supporting records. The insurer typically has 30–60 days to respond.
Was the appeal approved?
Coverage restored ✓
Keep all documentation on file.
Request an Independent Medical Review (IMR)
Most states offer a free external review by an independent medical reviewer. This is separate from the insurer's internal process and is a powerful tool — especially for parity violations.
Was the review successful?
Coverage restored ✓
The insurer is typically required to comply.
File a complaint with your State Insurance Commissioner
Document the denial pattern and any parity violations. Keep copies of all correspondence. Most states have online complaint portals.
File a federal complaint
For employer-sponsored plans: U.S. Dept. of Labor. For Medicare/Medicaid: CMS. For discrimination: HHS Office of Civil Rights. These agencies can investigate parity violations.
Contact MHIRTF for support
The Mental Health Insurance Reform Task Force provides complaint templates, grievance guides, and collective support for providers navigating these processes. Visit buildbetterhealth.org/mhirtf or complete our Get Involved form to connect.