The Utah Insurance Department has a staff of insurance experts available to help you understand your insurance coverage and answer your questions. If you have been unable to resolve a problem with your insurance company or agent, you may contact our staff for assistance, or file a written complaint. If your complaint involves health care insurance, please refer to the HEALTH CARE INSURANCE COMPLAINTS section below.
Our consumer service personnel are available to assist you between the hours of 8:00 a.m. and 5:00 p.m., Monday through Friday by calling:
Salt Lake City area: 801-538-3800
In-state toll-free: 1-800-439-3805
HOW TO FILE A COMPLAINT
- The online process requires that you open an account. When creating your account it is important to MAKE NOTE OF THE PASSWORD you select, it will be required to access the status of your complaint. Once your account has been created, you will be able to access the complaint form and submit your complaint. The purpose of a password-protected account is to provide secure transmission of the complaint and communication to and from the Insurance Department.
- If you are not able to complete your complaint online please contact our office for a printed complaint form to be sent to you.
- Once we receive your complaint:
- Your complaint will be forwarded to the party that you are complaining against for a response.
- We will review the response and provide you with our findings.
- The complaint process usually takes three to four weeks.
HEALTH CARE INSURANCE COMPLAINTS
Before submitting a complaint you will need to know some additional information. If you need to get it from your insurance company, check your insurance card for the company's contact information.
- Are you covered under an individual plan or an employer group plan?
- What state is the policy written in?
- What type of policy are you covered under — fully-insured or self-funded?
- If your policy is fully-insured and written in Utah, you can file a complaint with our office using our complaint portal.
- If your policy is fully-insured and written in a different state, you will need to file a complaint with the Department of Insurance in that state. You can find links to other states at https://content.naic.org/state_web_map.htm.
- If your policy is a self-funded plan, you will need to contact the US Department of Labor for assistance with your complaint. They can be reached at:
- If your policy is a Medicare Advantage Plan you will need to contact Medicare at the Centers for Medicare & Medicaid Service (CMS).
- 1-800-MEDICARE (1-800-633-4227)
- Medicare information statewide in Utah 1-877-424-4640
- If your policy is a Medicaid plan you will need to contact Utah Medicaid at 1-800-662-9651 or 801-538-6155.
SELF-FUNDED HEALTH BENEFITS. Many large employers do not purchase health insurance from an insurance company but rather the employer self-funds the health benefits provided to employees and use an insurance company or third-party administrator to handle the claims administration. In these cases, the Insurance Department does not have jurisdiction to assist you with a complaint. For information regarding Self-Funded Health Insurance Claims click here.
INDEPENDENT REVIEW. If you have had a claim denied by a health insurance company and have completed the appeal process outlined in your policy, you may be eligible for an independent review. For information regarding Independent Review of an Adverse Benefit Determination click here.
CLAIM HANDLING LAWS AND RULES
- For information regarding Claim Settlement Practices click here.