Health Insurance Complaint | Medicare Advantage

Complaint | Type of Insurance | Health | Medicare | Advantage

The Arizona Department of Insurance does not have jurisdiction over Medicare or Medicare Advantage plans.

File an Appeal or a Grievance

You should file a appeal or grievance with the plan. 

File a grievance if you are having a problem with the quality of care you got or are getting. For example, you may file a grievance if you have a problem calling the plan, you can't get an appointment with your doctor, or if you were treated rudely by a staff person with the plan. File an appeal if you have an issue with a plan's refusal to cover a service, supply, or prescription.  Medicare Advantage contractors are required to follow all CMS rules and guidelines for processing appeals and grievance. 

  • Contact the plan administrator using the contact information on the member's insurance identification card to obtain the forms and instructions you need to file an appeal or grievance.
  • Visit the U.S. Centers for Medicare and Medicaid Services (CMS) Medicare Managed Care Appeals & Grievances web page for information.
  • Get free, personalized help from Arizona's State Health Insurance Assistance Program (SHIP)
    • Local Phone: (602) 542-4446
    • Statewide Hotline: (800) 432-4040 (leave message). 
  • Contact Medicare with questions
    • General Information Phone: 800MEDICARE (800-633-4227)


Warning - Phishing Scam

We are aware of a phishing scam targeting insurance professionals claiming that the National Association of Insurance Commissioners received a complaint that the professional submitted a falsified claim. This fraudulent email displays the NAIC and CIPR logos, can originate from what appears to be an or email account, and instructs the recipient to click on a link to download the complaint notification.

Certain antivirus products will detect this as a malicious email.  If you receive a similar email and have any concerns, contact the NAIC Service Desk at (816) 783-8500 or [email protected].