Your Appeal Rights and Complaints

Last updated: March 30, 2016

Your Rights and What to Do When They Are Violated

What Appeal Rights Do Consumers Have?

You have a right to appeal an unfavorable coverage decision by your health insurance company.

  • If you own an individual policy, the insurance company must give you:

    1. A first-level internal appeal that is administered by the company

    2. Then a second-level external review administered by an independent third party.

  • For group policies:

    • the insurance company may require two levels of internal appeals before the external review.

For more information about how to appeal a health insurance company’s unfavorable decision, contact the Kansas Insurance Department at 800-432-2484.

You can also file complaints when claims are denied. Of you can file a complaint if you believe that your health insurance company isn’t following the legal appeals process properly.

Also, if you are dissatisfied with an eligibility decision made by the Health Insurance Marketplace, there is an appeals process.

  • The consumer can contact the Marketplace for more information.

Where Do Consumers File a Complaint for a Product Sold Inside or Outside the Health Insurance Marketplace?

First contact the insurance company with any complaint about benefits or services not being received from an insurer. Do this whether the insurer is on or off the Marketplace.

If consumers aren’t satisfied, they should contact the Kansas Insurance Department with help with questions or complaints.

To find out more about filing complaints, contact the Kansas Insurance Department at 800-432-2484 or www.ksinsurance.org/department/complaint.php.

This article is published on KansasMoney.gov. Find more information by contacting these state agencies: