New Jersey

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 disagree with your health plan’s decision, you have the right to file an appeal.

Below are links to the complaint forms and information for top health plans in New Jersey:

  • Aetna
  • Blue Cross Blue Shield
    • Login to your member account or call Member Services for more information on the appeals process.
  • 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
  • WellCare
  • Medicare Plans
  • My plan isn’t listed

STEP TWO – File a Complaint

You have the right to file a complaint with the State of New Jersey Department of Banking & Insurance New Jersey Department of Banking and Insurance 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.

You can find information on how to file a consumer grievance or appeal with the New Jersey Department of Banking and Insurance here.

You can also call the Department’s Consumer Hotline at (800) 446-7467.

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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.