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

You can contact the Texas Department of Insurance at (800) 252-3439. The Department is open from 8:00 a.m. to 5:00 p.m. Monday through Friday.

What happens after the Department receives my complaint?

Once the Department receives your complaint, it will contact your health insurer and attempt to resolve the dispute.[13] Your complaint will typically be resolved within 45 days from when the Department receives your complaint.[14] The Department can force your health insurer to...

How do I file a complaint?

If you are a Texas resident and you believe your insurer has done something illegal or unethical, you can file a complaint with the Department. Complaint information. You should complete the complaint form located here. Your complaint should include the following information:...

How long with the external review process take?

The external review process should take no more than 20 days from the date the external review organization receives your request.[9] If you requested an expedited external review, the process should take no longer than three business days after your request...

How do I request an external review?

To request an external review, you should complete the following steps: Complete request form. Your insurer should have provided you with the external review request form when it sent you the final adverse determination letter.[6] You should complete that form and submit...

In which circumstances can I apply for an external review?

During an external review, an independent third party reviews your insurer’s decision.[3] Your insurer will no longer have the final say over whether to approve a treatment or pay a claim. Under Texas law, you are entitled to request an external...

How long should the internal appeals process take?

The internal appeals process should take a maximum of 30 days after your health insurer receives the appeal for services you have not yet received and a maximum of 45 days if you have received the service or treatment but...

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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