Contact The Proper Agency - Where to File Medicare, Medicaid and Other Health Plan Complaints
Revised June 2009
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The Department of Insurance handles thousands of health insurance and HMO inquiries and complaints every year. However, not all health plans fall under our jurisdiction. This fact sheet provides information regarding plans that are not regulated by the Department.
Medicare
The U.S. Department of Health and Human Services (Social Security Administration) has jurisdiction over Medicare claims issues. However, if you have a question or complaint about a Medicare claim, you may contact the Department’s Senior Health Insurance Program (SHIP) at (800) 548-9034 for assistance.
Medicaid
Illinois Department of Healthcare and Family Services
Claims Processing
201 S. Grand
Springfield, IL 62763-3838
http://www.hfs.illinois.gov/managedcare/
All Kids
Illinois Department of Healthcare and Family Services: Medical Programs
State of Illinois – KidCare Unit
PO Box 19122
Springfield, IL 62794-9122
(866) 255-5437
http://www.allkids.com/
Illinois Comprehensive Health Insurance Plan (CHIP)
320 West Washington Street
Suite 700
Springfield, IL 62701-1150
(866) 851-2751 (Illinois only)(217) 782-6333
http://www.chip.state.il.us/
Government Employees
- Federal Employee Benefit Plans (includes postal workers)
U.S. Office of Personnel Management
Agency Employee Review
Retirement and Insurance Group
1900 E. Street NW
Washington, DC 20415-1000
(202) 606-1800
http://www.opm.gov/
- State of Illinois Employee Quality Care Health Plan, Life Insurance and Dental Insurance
Department of Central Management Services
Group Insurance Division
201 East Madison
Springfield, IL 62702
(800) 442-1300
http://www.state.il.us/cms/1_servicese/
- State of Illinois Employee HMO Plans
Illinois Department of Insurance
320 W. Washington Street
Springfield, IL 62767-0001
(877) 527-9431
http://insurance.illinois.gov
- Illinois Retired Teachers Plan or
Local Government Quality Care Health Plan
Department of Central Management Services
Bureau of Benefits
201 East Madison
Springfield, IL 62702
(800) 442-1300
http://www.state.il.us/cms/3_servicese_ben_choice/choice_retiree.htm
Self-Insured Employee Benefit Plans/Union Plans or Health & Welfare Plans
Many large employers provide health benefits for their employees through self-insured plans. Although self-insured plans are frequently administered by an insurance company, it is the employer and not the insurance company that bears the risk for paying claims. Generally, federal law exempts self-insured employer plans from state insurance regulation. The same is true of health & welfare benefit plans (union plans). However, the Department does have jurisdiction over adverse determinations of medical necessity and appropriateness to the extent required utilization review procedures are not followed by the entity performing those services for the self insured plan. In most cases, the Department of Insurance will accept your complaint and forward it to the plan in an effort to assist. We recommend you refer to your member handbook on how to file an appeal under the plan. The U.S. Department of Labor has some oversight of these plans.
- Northern Illinois:
U.S. Department of Labor
Employee Benefits Security Administration
Chicago Regional Office
200 W. Adams Street, Suite 1600
Chicago, IL 60606
(866) 444-3272
www.dol.gov/ebsa
- Southern Illinois:
U.S. Department of Labor
Employee Benefits Security Administration
Kansas City Regional Office
1100 Main Street, Suite 1200
Kansas City, MO 64105
(866) 444-3272
www.dol.gov/ebsa
Policies Purchased in Another State
Complaints should be sent to the Department of Insurance in the state where you purchased the policy. Check your insurance booklet or policy for the address or call us for that information. For HMOs, please contact the Division of Insurance for assistance.
Worker’s Compensation
The Department of Insurance generally does not have the authority to investigate complaints regarding Worker’s Compensation claims, including complaints about fee schedules. Inquiries and complaint should be directed to:
Written questions or complaints: |
Phone inquiries: |
Illinois Workers' Compensation Commission |
(866) 352-3033 Statewide |
James R. Thompson Center |
(312) 814-6611 Chicago Area |
100 W. Randolph, Suite 8-200 |
(815) 987-7292 Rockford Area |
Chicago, IL 60601-3275 |
(309) 671-3019 Peoria Area |
|
(217) 785-7087 Springfield Area
and Southern Illinois |
|
(618) 346-3450 Collinsville Area |
For More Information
Call our Consumer Services Section at (312) 814-2427 or
our Office of Consumer Health Insurance toll free at (877) 527-9431
or visit us on our website at http://insurance.illinois.gov
