Questions & answers · Health insurance
My health insurer denied my appeal. Who regulates my plan, and where do I complain?
Health insuranceComplaint / outside reviewTexasChecked Nov 5, 2026
From K.Actuary, founded by Sangmin Kwon, ASA · sources checked 2026-11-05 · Source: TDI View original ↗
In short
- First appeal to the plan. Then ask for an outside review.
- Your insurance card shows who checks your plan.
- Appeal within 180 days. Ask for outside review within four months.
What this means
TDI's steps when a health plan denies a treatment, procedure or medicine [1]: 1. Appeal to the insurance company. The denial notice should tell you how; you must usually appeal within a set time. 2. Ask for an external review if you aren't happy with the appeal or were denied care for a life-threatening condition. An independent reviewer decides whether the insurer must pay. External reviews are free to you. TDI says the U.S. Department of Labor or HHS oversees external review for most plans in Texas; TDI can help if you have a fully insured plan, and it can't overturn an independent reviewer's decision. 3. File a complaint. 4. Talk to an attorney about your legal options.
Who to complain to depends on the plan. TDI says to file with TDI if your insurance card has "TDI" or "DOI" on it, or if you have a Medicare supplement, long-term care, disability, short-term or other limited benefit plan. TDI doesn't regulate Medicare, Medicaid, non-HMO CHIP plans, military plans, government employee plans or teacher plans [1]. For an employer plan, DOL's EBSA takes questions at 1-866-444-3272 [2].
Your next step
+ deadline: look at your insurance card to see who regulates the plan. Federal deadlines: file the internal appeal within 180 days (6 months) of the denial notice [3]. Ask for external review within 4 months after you receive the final denial [4].
Where this comes from (4)
[1] TDI · checked 2026-11-05
Step 1: Tell the insurance company you want to appeal its decision. … The notice you got from the health plan telling you that it denied your treatment or service should tell you how to appeal. … You must usually ask for an appeal within a certain time period. … Step 2: Ask for an external review. If you aren't happy with your appeal or were denied care for a life-threatening condition, you can ask for an external re…
[2] U.S. Department of Labor (EBSA) · checked 2026-11-05
contact the Department of Labor's Employee Benefits Security Administration (EBSA) at 1-866-444-3272
[3] HealthCare.gov · Internal appeals (row aca-hc-int) · checked 2026-11-05
You must file your internal appeal within 180 days (6 months) of receiving notice that your claim was denied.
[4] HealthCare.gov · External review (row aca-ext-file) · checked 2026-11-05
You must file a written request for an external review within 4 months after the date you receive a notice or final determination from your insurer that your claim has been denied.
How we found this
We matched your question to 4 official sources, quoted the exact lines, and re-checked each quote against its source on 2026-11-05.
What we don’t know yet
Your own plan or notice may say something different. If your letter cites another rule, send it and we will look again.
Every answer is checked against the official rule it quotes.
Information only — not legal advice. Your plan, insurer or agency decides.
This answer quotes the official sources listed above, with the date we checked them. Your own policy, notice and state rules control. We are not your lawyer or your insurer. We don’t file, argue or negotiate claims for you — you send any letter or form yourself.
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