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 naic.org or gmail.com 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].