PPO Complaints
This page describes what to do if you have a PPO or fee-for-service insurance (unless it is a Blue Cross/Blue Shield PPO).
Topics on this page
- How to file a complaint with your plan
- How to file a complaint with the state
- Request an Independent Medical Review (IMR)
How to file a complaint with your plan
- Call your plan and ask how to file a complaint. Ask if you can file a complaint over the phone.
- Ask how soon the plan will tell you its decision.
- Ask for an expedited review of your complaint if your problem is urgent.
How to file a complaint with the state
- Call the Department of Insurance Consumer Hotline at 1-800-927-4357 between 8am and 5pm, Monday to Friday.
- Be sure to explain if your problem is urgent.
Request an Independent Medical Review (IMR)
- An IMR is a review of your plan’s denial of medical treatment. Doctors who are not part of your plan make an independent decision about the denial.
- The plan must do what the IMR decides.
- For information on IMR, visit the Department of Insurance IMR website.
- Call the Department of Insurance Consumer Hotline at 1-800-927-4357 between 8am and 5pm, Monday to Friday.
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