We are here to help! We can help resolve issues that are within our jurisdiction. For issues that are outside our jurisdiction, this web page will help you determine who you can contact for help.
By continuing with filing an insurance complaint, you ACKNOWLEDGE the following:
What We Can and Cannot Do
We Can Provide Information
- Visit our Insurance Information page, with resources that can help you make informed insurance-related decisions and help you understand your insurance policy.
We Can Help With...
- Certain surprise health care bills through a surprise billing program.
- Health provider grievances
- Denied health insurance claims and denied requests for health care services through the health care appeals process
We Can Investigate...
- Claim-handling delays
- Claim denials
- Unsatisfactory settlements
- Non-renewals and cancellations
- Delays in premium refunds
- Underwriting errors
- Conflicting information from your insurer
- Other insurance-related disputes
- Give legal advice, act as a lawyer or claims adjuster, or interfere in a pending lawsuit
- Recommend one insurer or agent over another
- Make liability decisions/ determine who is at fault/ determine the amount of money owed to you
- Determine who is being truthful when accounts of what happened differ
- Resolve a complaint if the only evidence is your word against the word of others
- Address issues we can't legally enforce
- Tell you who the insurance company is for a particular individual or business (we do not have that information).
- Intervene in disputes between insurance companies and their employees or contractors (agents, etc.).
- Help resolve complaints that are not subject to the insurance laws of Arizona or that are regulated by other Arizona state agencies, including but not limited to:
- Medicaid/AHCCCS benefits (see AHCCCS Rights & Responsibilities)
- Medicare and Medicare Advantage Plans (see Medicare.gov)
- TriCare (see Tricare.mil)
- Federal Employee Benefit Plans (help is available from the U.S. Office of Personnel Management)
- State of Arizona Employee or Retiree Benefit Plans (help is available from the ADOA Benefit Services Division or from your retirement system)
- Continuation of health coverage under COBRA (see U.S. Department of Labor COBRA information)
- Arizona unemployment insurance (see Department of Economic Security Unemployment Insurance Benefits)
- Employer self-funded health benefit plans (see U.S. Department of Labor Employee Benefits Security Administration)
If a matter is within our jurisdiction, this website will tell you whether you should file a complaint, grievance, or appeal. For matters that are outside our jurisdiction, this website immediately provides the information you can use so you do not spend time submitting a complaint and waiting for a response, only to be told that we do not have the authority to help with the matter.
IMPORTANT: Each submitted insurance consumer complaint, the response to the complaint, and many of the related documents become a public record pursuant to Arizona law.
File a complaint if you believe we have jurisdiction in the matter. We will conduct a preliminary review of your complaint to verify that DIFI has jurisdiction. We will let you know if DIFI does not. If DIFI has jurisdiction, we will ask the respondent (insurance entity) to respond to the complaint. After receiving the response, DIFI will evaluate the complaint and response, will conduct any necessary research to substantiate information, may reach out to you for additional information if needed, and will determine if the respondent violated Arizona law, rules or policy terms. We will notify you when the case has been closed.