Internal and External Grievance Procedures

An Indiana consumer who is enrolled under a health maintenance organization contract or is insured under an accident/sickness insurance policy has the right to file a grievance and an appeal of a grievance decision with the insurance company.  Each company is required to develop procedures and file them with the Department of Insurance.

 

When you receive a denial, your Explanation of Benefits (EOB) form will include details on how to file a grievance.  It is important to follow the deadlines stated in your EOB or your policy or certificate, which will also include a toll free number and mailing address.

 

The filing procedures as provided by the insurance companies can also be found by clicking on the insurance company name below. Your insurance company’s customer service number is the best place to start with questions regarding the grievance process.  If they are unable to help, you may contact the IDOI’s Dawn Parry at 317-232-2396 or toll free 800-622-4461.

Aetna Companies

American National Insurance Company

American National Life Insurance Company of Texas

Anthem Inc.

Baptist Health Plan

CareSource Indiana Inc.

Cigna Healthcare of Indiana Inc.

Cigna Life and Health Insurance Company

Connecticut General Lif Insurance Company

Federated Mutual Insurance Company

Fidelity Security Life Insurance Company

Golden Rule Insurance Company

HealthMarkets Insurance Company

Humana Companies

Illinois Mutual Life Insurance Company

Indiana University Health Plans Inc.

Life of America Insurance Company

MdWise Marketplace Inc.

Medical Benefits Mutual Life Insurance Company

Mid-West National Life Insurance Company of Tennessee

National Guardian Life

New Era Life Insurance Company of the Midwest

New Era Life Insurance Company

Nippon Life Insurance Company of America

Pekin Life Insurance Company

Philadelphia American Life Insurance Company

Physicians Health Plan of Northern Indiana Inc.

Southern Indiana Health Organization

Standard Life and Accident Insurance Company

The Prudential Insurance Company of America

Trustmark Insurance Companies

United Behavior Health

UnitedHealthCare Insurance Company