File a Provider Complaint

The Consumer Services Division of the Department of Insurance stands ready to assist you in resolving problems with insurance companies licensed in Indiana.

Not all companies are licensed in Indiana. Contracts of insurance are governed by the state in which the contract is sold and complaints should be directed to the Department of Insurance in the state where the company is licensed and the policy sold.

The Indiana Department of Insurance has no jurisdiction over self-funded employer group health plans and complaints regarding self-insured plans must be addressed by the Federal Department of Labor.  

Similarly, the Indiana Department of Insurance has no jurisdiction over Federal programs such as Medicare or Medicaid.

If the claim involves Worker’s Compensation, direct your complaint to the Worker’s Compensation Board, 402 W. Washington St. Rm. W196, Indianapolis, IN 46204, unless there has been an award. We do not accept these complaints and will return them.

The Department is an administrative agency of State Government and cannot act in the capacity of a court.  We will thoroughly investigate your problem, advise you whether the insurance company has acted according to the terms of the policy and within the confines of law. If they have not, the Department will take appropriate action.  Examples of problems that we can help with include non-payment of or continuous late payment of claims, down-coding of claims without notice, and payment of non-network provider fees instead of usual and customary fees.

Claims Payment – THE DEPARTMENT CANNOT ACT AS YOUR COLLECTION SERVICE. We do expect companies to take prompt action on claims, to fully investigate all pertinent facts concerning the claim, and to make all insurance settlement offers in good faith.  Before you ask us for assistance, you should attempt to solve your issues directly with the insurer.  If your effort is not successful and payment on the clean claim is more than 90 days late, we will be glad to assist in attempting to resolve the problem.

In order to efficiently address your concerns, please follow these guidelines:

• The healthcare provider or the patient can file a complaint with the Department.
• A separate complaint should be filed for each patient involved; complaints received that deal with multiple patients at a time will be returned to you for additional information.
• All requests for assistance must be in writing and should include:
  • A cover letter describing the problem and how you think the problem should be resolved.
  • Complete name/address of insurance company (i.e. United American Insurance Co.- not just United).
  • A copy of the patient’s insurance card.
  • Policy information (insured’s name, patient’s name, group/member/policy numbers).
  • Information on claims involved (claim number, date of service, date filed with insurance).

The monetary amount on the claim must be $250 or more for healthcare provider claims and $5000 or more for hospital claims. Anything less will be sent back to the complainant.

­What Next – When your complaint is received at the Department it will be assigned a case number and you will receive an acknowledgement letter.  You should refer to the case number when contacting the Department about the case. The Department will notify the insurance company of the complaint and ask for their explanation of the problem. Insurers have 20 business days from receiving the complaint to respond.  The Department will review the complaint information and the company’s explanation to determine whether the company is justified in their actions or not. We will then suggest the appropriate resolution to the problem and take the administrative action when appropriate. The Department will communicate with you throughout the investigation.