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

You can contact the New Jersey Department of Banking and Insurance at (609) 292-7272 or through the Consumer Hotline at (800) 446-7467. The Department is open from 9:00 a.m. to 4:00 p.m., Monday through Friday.

What happens after the Department receives my complaint?

Your complaint will be assigned to an investigator. The investigator will review the complaint and contact your health insurer for a response. The insurer has 14 days to respond. Once the review is complete, the investigator will notify you of...

How do I file a complaint?

If you are a New Jersey resident and your insurer still denies your claim after the external review process, you can file a complaint with the Department. Complaint information. Your complaint should include the following information: The name, address, email address,...

How long will the external review process take?

The external review process should take no more than 45 days after the external review organization has received your request. If you requested an expedited external review, the process should take no more than 48 hours.[16]

How do I request an external review?

You should submit your request for an external review to the New Jersey Department of Banking and Insurance (“Department”) within four months from when your insurer sent you the most recent decision.[12] Information. You can find a copy of the external...

In what circumstances can I apply for an external review?

During an external review, an independent third party reviews your insurer’s decision.[9] Your insurer will no longer have the final say over whether to approve a treatment or pay a claim. Under New Jersey law, you are entitled to request an...

How long should the internal appeals process take?

The first stage of an internal appeal should take no longer than 10 days to complete, while the second stage should be completed in no more than 20 business days.[7] For expedited internal appeals, the first stage should be completed...

How do I request an internal appeal if I have an employer-sponsored group plan?

If you have an employer-sponsored group plan, you will need to complete two stages of internal appeals.[3] During the first stage, you or your provider should call your health insurer’s medical director or the physician responsible for denying your claim.[4] You may...

How do I request an internal appeal if I have a plan other than an employer-sponsored group plan?

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. The appeal process differs based on whether you have an...

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