Who should I call if I have any questions about filing a complaint?

You can contact the Florida Division of Consumer Services at (877) 693-5236 (in-state) or (850) 413-3089 (out-of-state). Division specialists are available to answer your questions 8:00 a.m. to 5:00 p.m. Monday through Friday.

What happens after the Division receives my complaint?

An investigator for the Division will contact your health insurer regarding your complaint. The investigator should resolve the complaint within 30 days.[12]

How do I file a complaint?

If you are Florida resident and your insurer denies your coverage after the external review process, you can file a complaint with the Florida Division of Consumer Services (“Division”). You should have the following information available when filing your complaint:...

How long will the external review process take?

The external review process should take no more than 60 days. If you request an expedited external review, the process should take no longer than four business days after your request is received.[9]

How do I request an external review?

If your insurer still denies you coverage after you requested an internal appeal or if your situation is urgent, you can request an external review of the insurer’s decision.[6] During an external review an independent third party reviews your insurer’s decision.[7]...

What if I can’t wait for an internal appeal because my situation is urgent?

The internal appeals process should take a maximum of 30 days if you have not yet received the requested service or treatment and a maximum of 60 days if you have received the service or treatment but are waiting for...

How do I appeal the decision?

If your insurer denies your claim, you have the right to an internal appeal.[1] This means you can ask your insurer to conduct a full and fair review of its decision. To appeal the denial, you should do the following: Review...

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