Louisiana

STEP ONE – Notify Your Health Plan

The first thing you need to do is file a complaint with your health plan. Under Louisiana law, the Louisiana Department of Insurance (LDI) requires your health plan to provide notice that internal appeals processes are available. Your health plan must provide you instructions on how to request an internal appeal. Follow the steps below to file a complaint and appeal with your health plan:

• 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 your health plan denied your claim, you can appeal the decision by submitting a written request within 180 days.
• If your health plan denies your appeal, you may be able to request an external review conducted by an independent review organization assigned by the LDI.
• You must submit your request for an external review within four months of receiving your health plan’s denial.

Below are links to the complaint forms of Louisiana’s top health plans:

• Aetna Better Health of Louisiana
• Blue Cross Blue Shield of Louisiana
• Coventry Health Care of Louisiana
• Louisiana Healthcare Connections
• UnitedHealthCare
  • Log on to MyUHC.com and complete the “Appeals and Grievance Form”
  • Select: Claims and Accounts > Medical Appeals and Grievances > Member Service Request Form
  • Fax or mail the completed form to the UnitedHealthcare address listed in the instructions
• Vantage Health Plan
• My plan isn’t listed

Medicare Plans

STEP TWO – File a Complaint

You have the right to file a complaint with the Louisiana Department of Insurance (LDI) if you have a problem getting the services you need, including quality and affordable health care. To file a complaint you must first complete your health plan’s appeal and/or external review process.

• File a complaint using the LDI’s online consumer complaint portal here or obtain a hardcopy here.
• If you have further questions on how to file a complaint with the LDI, contact the Office of Consumer Advocacy and Diversity at (800) 259-5300.