Once the Office receives your complaint, a Health Care Section agent will determine if the Office is the most appropriate agency to address your concern.[21] If so, the agent will forward a copy of your complaint to your health insurer. Your insurer must respond within 15 business days.[22] After reviewing all documentation, the agent will send you a decision.  You should expect the process to take a minimum of 30 days.[23] In many cases, the insurance company will agree to reverse or reprocess the claim.

If the Health Care Section is not the appropriate agency to handle your complaint, the agent will forward it to the appropriate agency and advise you where it has been sent.[24] If your complaint involves an allegation of fraud or possible criminal activity on the part of the insurer, your complaint may be sent to the Insurance Fraud Section or the Criminal Prosecutions Section or another state or federal agency, depending on the facts of your case.