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

You can contact the Illinois Department of Insurance Customer Assistance Hotline at (866) 445-5364. The Department is open from 8:00 a.m. to 8:00 p.m. Monday through Saturday.

What happens after the Department receives my complaint?

Once the Department receives your complaint, it will be assigned a file number. A copy of the complaint will be sent to your health insurer, who has 21 days to respond. An analyst will review the complaint and the insurance...

How do I file a complaint?

If you are an Illinois resident and your insurer denies your coverage after the external review process or your insurer determines your claim is not eligible for external review, you can file a complaint with the Illinois Department of Insurance...

How long will the external review process take?

After the review organization receives all of the necessary information relating to your claim, you should receive a response within the following timeframes: No more than 45 days for standard external reviews; No more than 72 hours for expedited external...

How do I request an external review?

During an external review, an independent third party reviews your insurer’s decision.[8] You can request an external review of the insurer’s decision in the following circumstances: You requested an internal appeal and did not receive a response within 30 days (if...

What if I can’t wait for an internal appeal because I may experience an increased health risk or 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 request an internal appeal?

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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