DOI Pat Quinn Governor Andrew Boron, Director

Contact The Proper Agency

Where to File Medicare, Medicaid and Other Health Plan Complaints

Updated 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 (Centers for Medicare & Medicaid Services) 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

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)

  • 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

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
    http://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
    http://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 Department 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

  • Illinois Workers' Compensation Commission
    James R. Thompson Center
    100 W. Randolph, Suite 8-200
    Chicago, IL 60601-3275

Phone Inquiries

(866) 352-3033 Statewide
(312) 814-6611 Chicago Area
(815) 987-7292 Rockford Area
(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