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

Step 1: Document everything

Get the denial in writing. Note dates, reference numbers, and contact names. Gather clinical documentation and your Explanation of Benefits (EOB).

Step 2: 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? If yes, coverage is restored ✓ — Keep all documentation on file. If no, continue to the next step.

Step 3: 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? If yes, coverage is restored ✓ — The insurer is typically required to comply. If no, continue to the next step.

Step 4: 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.

Step 5: 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.

At Any Stage: 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.

At every step: document all communications in writing, keep copies, and follow up in 7–10 days if there is no response. This document was created by the Mental Health Insurance Reform Task Force. Visit buildbetterhealth.org or email info@buildbetterhealth.org.