Complaints, Grievances and Appeals

How to file a complaint, grievance or appeal

You have the right to file a complaint, grievance or appeal about:

  • Innovation Health
  • Your plan
  • A health care service, provider or professional

Get help from Innovation Health

Call the number on the back of your member ID card.

You may mail or fax your information by printing the following form:

Get help from your state

Your state insurance office can help you if you don’t agree with a decision made by your health plan or if you decide to appeal a decision.

  • Choose the state you live in if your medical plan is self-funded.
  • Choose the contract state if your medical plan is insured.

If you are not sure, ask your employer or call the toll-free number on the back of your medical plan ID card to find out which type of plan you have.

Get help from the federal government

The Health Care Reform law includes rules about appeals. Many plans have to follow these rules. If your plan is covered by the law*, you can contact the Employee Benefits Security Administration for help at 1-866-444-EBSA (3272).

Living outside the United States?

You may have a medical plan that covers you or your family while you’re living outside the United States. If it's subject to the U.S. Health Care Reform law, choose the state where the plan sponsor has its main place of business. Call the toll-free number on the back of your medical plan ID card if you're not sure.

District of Columbia

Consumer Assistance Program:
District of Columbia Healthcare Finance
Office of the Ombudsman
441 4th St., NW (9th and 10th Fl.)
Washington, DC 20001
877-685-6391

healthcareombudsman@dc.gov

http://ombudsman.dc.gov

District of Columbia Department of Insurance - for insured plans only
Government of the District of Columbia
Department of Insurance, Securities and Banking
810 First Street
NE, Suite 701
Washington, DC 20002
202-727-8000
Fax: 202-535-1196
TTY: 711
Email: disb@dc.gov

http://disb.dc.gov/

Maryland

Maryland Department of Insurance - for insured plans only
Maryland Insurance Administration
Customer Services Division
200 Paul, Suite 2700
Baltimore, MD 21202
800-492-6116

http://insurance.maryland.gov/Consumer

Virginia

Virginia State Corporation Commission - for insured plans only
Bureau of Insurance
Tyler Building, 1300 East Main Street
Richmond, Virginia 23219
800-552-7945 (Virginia only)
804-371-9741

http://www.scc.virginia.gov/boi/index.aspx

Bureauofinsurance@scc.virginia.gov (email)