Having difficulty with the mental health benefits under your health insurance policy? Some problems require you to APPEAL, while others call for a COMPLAINT. Generally speaking, if an insurance company denies a request for service or claim for service as not covered or as not medically necessary that should be submitted as an APPEAL. Other health insurance problems should be filed as a COMPLAINT.
For instructions on how to file an Appeal or a Complaint, click the links below.
| WHAT KIND OF PROBLEM ARE YOU HAVING? |
WITH YOUR HEALTH INSURER |
WITH THE DIVISION OF INSURANCE |
OTHER |
|---|---|---|---|
|
I can’t find an in-network doctor to help me? |
✓ | ||
| The insurer is denying prior-authorization of my visit to a doctor | ✓ | ||
| The insurer is denying my referral to a specialist | ✓ | ||
| The insurer is denying coverage for a particular medication | ✓ | ||
|
Why doesn’t my insurance policy include mental health benefits? |
✓ | ||
|
My insurance company won’t respond to my coverage questions. |
✓ |
|
|
| My insurer is not responding to my urgent request for MH/SUD services | ✓ | ||
| My insurer only paid a small portion of my claim | ✓ | ||
| I’m having problems with my AHCCCS (Medicaid) plan | https://azahcccs.gov/ | ||
|
I’m having problems with my Medicare plan |
|||
| I received a Surprise Bill for services | https://difi.az.gov/consumer/i/health/surprisebill |
IMPORTANT NOTE: Many large employers provide health benefits using a “self-funded” or “self-insured” program which are generally regulated by the U.S. Department of Labor.
Self-funded plan ID cards often contain one of the following phrases near the insurer's name: "Administered by," "As administrator for," "Administrative services only," or "ASO." Check with your employer benefits office to confirm.
Health insurance ID cards may contain the phrase "Underwritten by" or "Insured by" near the insurer's name. Starting in 2022, ID cards must display "AZDOI" if the coverage is NOT self-funded, Medicare, or Medicaid.