Colorado

STEP ONE – Notify Your Health Plan

The first thing you need to do is file a complaint with your health plan. To file a complaint and appeal, follow the steps below and read this brochure outlining the health plan review process and timelines.

  • Call the member/customer service phone number for your health plan.
  • Tell them you want to file a formal complaint and then explain the problem.
  • You can also file your complaint by letter, email, or online through your health plan’s website (see below).
  • If you disagree with your health plan’s decision, you have the right to file an appeal within 180 days.
  • A physician not involved in the original denial of care must review your appeal of denial. You must receive a decision in writing or electronically within 30 days.
  • A second review is required if your first appeal is denied – with a meeting scheduled within 60 days. Your health plan must give a decision 7 days after that.
  • Regulators allow an external appeal if the health plan denies your appeal a second time. The health plan must make a decision on external appeals within 45 days of the request’s filing.

Below are links to the complaint forms for Colorado’s top health plans:

Medicare Plans

STEP TWO – File a Complaint

You have the right to file a complaint with the Colorado Division of Insurance (DOI) if you have a problem getting the services you need, including quality and affordable health care. To file a complaint you must first file an appeal with your health plan.

  • File a complaint with the DOI here.
  • Call the DOI helpline: (800) 930-3745.

The Chronic Care Collaborative (CCC) is the guiding voice, made up of 34 leading, voluntary health organizations within Colorado, whose main purpose is to advocate, inform, and educate regarding health policy issues that affect people living with a chronic disease. The CCC influences policy, shares information, promotes prevention and wellness, and provides a forum that ultimately benefits people living in Colorado.

In addition, to filing a complaint with the Colorado Division of Insurance, we encourage you to share your story. Both actions will help the CCC advocate to improve access to health care for all people in Colorado, especially the one in four Coloradans living with a chronic condition.

For additional assistance, information, or Colorado specific resources, please check the CCC’s website: http://www.chroniccarecollaborative.org/

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Know Your Rights

State and federal law protects your rights. When you sign up for a health plan and/or if you have problems accessing care through your health plan, it is important to know your rights.