If you are an Idaho resident and your insurer denies your coverage after the external review process, you can file a complaint with the Department.[11]

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 name of the insured individual, if different than the Complainant;
  • The name of insurance company;
  • Policy number, claim number, and date of loss;
  • 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 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.[12]

How to submit. You can submit the complaint and supporting documents online here, fax them to (208) 334-4319, or mail them to:

Idaho Department of Insurance
Consumer Affairs Section
700 W. State Street, 3rd Floor
Boise, ID 83720-0043[13]