Ohio

STEP ONE – Notify Your Health Plan

The first thing you need to do is file a complaint with your health plan. 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 you are unable to resolve your complaint with your health plan, contact the Consumers Services Division at the Ohio Department of Insurance for assistance in filing an appeal: (800) 686-1526.

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

• Ambetter
• Buckeye Community Health Plan
• CareSource
• Community Insurance Company (Anthem BCBS)
• Healthspan
• Humana (Medicare)
• Humana (Individual & Family)
• Medical Health Insuring Corp. of Ohio (Medical Mutual)
• Molina
• Paramount
• Premier Health Plan
• Summa
• United Healthcare
  • 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
• My plan isn’t listed

Medicare Plans

STEP TWO – File a Complaint

You have the right to file a complaint with the Ohio Department of Insurance (ODI) 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 process.

• File a complaint with ODI here.
• To request a complaint form and for further information contact Consumer Services: (800) 686-1526 or browse ODI’s online toolkit Understanding the Health Coverage and External Review Appeals Process.