Group health and individual plan appeals

If you have employer-sponsored or private health insurance and believe that your legal rights under the Affordable Care Act (ACA) have been violated, you should contact your health insurer first to understand its coverage decision. Always attempt to resolve the issue through the insurer's appeals process (typically described on any claim form, benefits statement or in the insurance policy paperwork) first.

If the issue cannot be resolved directly with the insurance company, the next step is to contact your state insurance commissioner’s office. Finally, you can contact the Health Insurance Hotline at the Center for Consumer Information and Insurance Oversight (CCIIO) at Health Insurance Hotline at (410) 786-1565 or email: phig@cms.hhs.gov.

Self-funded, grandfathered, short-term and catastrophic health plans are not bound by all of the ACA rules, and may have different appeals processes. For more specifics, review your plan materials or visit healthcare.gov.