If you are a North Carolina resident and you believe your insurer did something illegal or unethical, you can file a complaint with the North Carolina Department of Insurance, Health Insurance Smart NC Division (“Smart NC”).

Complaint information. Your complaint should include the following information:

  • The name, address, email address, and telephone number of the person filing the complaint (“Complainant”);
  • The Complainant’s relationship to the insured individual;
  • The name of the insured individual, if different than the Complainant;
  • The name of insurance company;
  • The policy or group number, claim or certificate number, and date of loss;
  • The name of the insurance agent and adjuster in your case; and
  • The details of the complaint.

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

  • A copy of your insurance card;
  • Copies of determination letters 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.[28]

How to submit. The complaint and supporting documents may be submitted online here or mailed to the following address:

North Carolina Department of Insurance
Health Insurance Smart NC
1201 Mail Service Center
Raleigh, NC 27669-1201[29]