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Appeals and Complaints

The health insurance market in Nevada isn’t perfect, as with any other state. There is always the potential that you could run into a problem with your health insurer that calls for a consumer complaint. Whether your claim has been denied and you need to file an appeal, or you feel a company policy has been violated, it is necessary to report. In order to formally and efficiently resolve your issue, it is best to personally address it with your insurance company first. All insurance companies have staff who are trained to handle consumer problems, and they should be willing to work through your specific issue.

 

Contact Your Health Insurance Company

To contact your insurance company directly, their website should guide you through the process for making an appeal or a complaint. Below are the contact, forms and other information for each insurer in Nevada when you find it necessary to report an issue. The phone number should also be listed on the back of your insurance ID card.

 

Aetna Appeals & Complaints

Anthem Appeals & Complaints

Coventry One Appeals & Complaints

Health Plan of Nevada Member Services: 702-242-7300 or 800-777-1840

Sierra Health and Life Member Services: 800-888-2264

UnitedHealthOne Support: 800-657-8205

 

Contact the Nevada Division of Insurance

If resolving an issue with your insurer as proven ineffective, you may then proceed through the Nevada Division of Insurance and submit a complaint. Their website allows you to submit a form online, or print and fill out a paper version to send to your nearest Division of Insurance office. Once your complaint has been received, the Consumer Officer logs the complaint into the Complaint Database, will send you an acknowledgement letter, and sends a letter with a copy of your complaint to the insurance company or the agent or broker affiliated with your Consumer Complaint.

Your insurance company has 28 days to reply to the Division of Insurance and address the issued presented in the complaint. Once the insurer gives their response, you will be promptly notified by the Division. If you have not heard from the DOI within 30 days from the date of your acknowledgment letter, you may contact the Consumer Officer appointed to your case to review your complaint status.

Nevada DOI Online Complaint Form

More information on filing a complaint with the Division Of Insurance.

 

 

Sources:

 

1. Nevada Division of Insurance. “How to Submit a Complaint”. http://doi.nv.gov/scs/complaint.aspx.

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