Filing a Complaint With DIFS
You do not always need an attorney to resolve most claim disputes with an insurer. Start with contacting the insurer's customer service department. Most insurers have toll-free telephone numbers located on the back of your insurance card.
If a satisfactory resolution is not received, ask about the insurer's appeal process or file a written complaint with the Department of Insurance and Financial Services (DIFS).
DIFS will send the insurer a copy of the complaint and ask them to explain their position. Insurers are required by law to respond to DIFS. We will review the facts to ensure the health insurer has complied with your contract language and all rules and regulations.
What You Should Know
- How to File a Complaint With DIFS
Complaints can be submitted in the following ways:
Mail: Department of Insurance and Financial Services
Office of Consumer Services
PO Box 30220
Lansing, MI 48909
Contact DIFS toll-free at 877-999-6442 to request a complaint form to be sent to you via mail, email or fax.
- Health Care Provider Complaints
DIFS regulates the business of insurance transacted in Michigan. Our authority pertains to contracts issued in Michigan. DIFS accepts complaints from parties involved in the contract, such as the insured, policyholder, or certificate holder. Because a health care provider is usually not a party to the health plan, DIFS generally does not accept complaints from providers. There are some exceptions to this rule.
DIFS will pursue appropriate complaints from providers acting as the authorized representative of a patient; however, a signed and dated Designation of Authorized Representative form must be included with the complaint.
DIFS will accept complaints from providers having problems with receiving timely payment for submitted claims without any errors or other issues. These claims are referred to as “clean claims” and must be paid within 45 days after it is received by the health plan. For more information on clean claims and to obtain the Clean Claim Report form, visit www.michigan.gov/DIFS.
If you have a provider-related billing dispute, these complaints can be submitted to the Michigan Attorney General Consumer Protection Division for review. Their office can be reached toll-free at 877-765-8388 or www.michigan.gov/ag.
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