Appeals and Complaints
Understanding Appeals and Complaints: What to Do When Coverage Is Denied or Care Is Delayed
If your health insurance provider has denied coverage for a service, delayed necessary care, or issued a bill you believe is incorrect, you have the right to appeal and file a complaint. The first step is always to contact your insurance company directly—many issues can be resolved through a formal internal appeal. If that doesn't lead to a resolution, you may be eligible to file an external appeal or bring your complaint to a state or federal agency for further review.
We know the process can be confusing and frustrating, especially when your health is on the line. That’s why we’ve gathered trusted resources to help you understand your rights, navigate the appeals process, and take the next step with confidence. Whether your plan is through Medicaid, Medicare, the Marketplace, or a private insurer, there are tools available to support you.
Click the links below to explore guides, official complaint portals, and step-by-step instructions based on your coverage type and location.
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Contact your current carrier appeals department
New Mexico Resources
Federal Resources