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:

  • The name, address, and telephone number of the person filing the complaint (“Complainant”);
  • The name and address of the insured individual, if different than the Complainant;
  • The name of the provider;
  • The name of insurance company;
  • Policy number, claim number, and date of loss;
  • Type of insurance and reason for complaint;
  • The details of the complaint; and
  • What you consider to be a fair resolution.

Supporting documents. You should submit the following supporting documents with your complaint:

  • A signed medical record release form (included with the complaint packet);
  • A copy of your insurance card; copies of coverage denials or adverse benefit determinations from your insurer;
  • Copies of any determinations made by internal and external reviewers;
  • Any materials submitted with prior appeals and complaints;
  • Supporting documentation from your health care provider;
  • A copy of your insurance policy; and
  • All responses from your insurer.[11]

How to submit. You can submit the complaint and supporting documents by using one of the following methods:

MC 111-1A
Consumer Protection
Texas Department of Insurance
P.O. Box 149091
Austin, TX 78714-9091

  • Deliver in person to the following address:

Texas Department of Insurance
Consumer Protection (111-1A)
333 Guadalupe Street
Austin, TX 78701[12]