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 (“Department”).

Click here for the complaint form. Your complaint should include the following information:

  • The name, address, email address, and telephone number of the person filing the complaint (“Complainant”);
  • The name, address, email address, and telephone number of the insured individual, if different than the Complainant;
  • The name of insurance company;
  • The insured’s individual identification number;
  • The name of the employer or group if it’s a group plan;
  • Claim number and date of service; and
  • The details of the complaint.

You can attach supporting documents to complaints submitted online or you can fax or mail supporting information.[14] You should submit the following documents as supporting information:

  • 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 doctor;
  • A copy of your insurance policy; and
  • All responses from your insurer.[15]

The complaint may be submitted online here, faxed to (217) 558-2083, or mailed to:[16]

Illinois Department of Insurance
320 W. Washington Street
Springfield, IL 62767