STEP ONE – Notify Your Health Plan

The first thing you need to do is file a complaint with your health plan. Most health plans in Pennsylvania have a two-level appeal process to handle grievances and complaints. 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 disagree with your health plan’s decision, you have the right to an internal appeal.

Below are links to the complaint forms for Pennsylvania‘s top health plans:

Medicare Plans


STEP TWO – File a Complaint

You have the right to file a complaint with the Pennsylvania Department of Health and/or the Pennsylvania Insurance Department 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.

The Department of Health reviews appeals that concern quality of care or quality of service issues.

  • Call the Department of Health to file a quality complaint: (888) 477-2787 or (888) 466-2787.

The Insurance Department reviews appeals relating to contract exclusions, coverage disputes and other insurance-related issues.

  • File a complaint with the Insurance Department online here or request a form here.
  • Call the Insurance Department’s helpline: 1 (877) 881-6388.
  • You can expect the investigator to contact you within 30 days.
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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.