Last updated: May 21, 2020
This section tells you how to appeal decisions that the Marketplace or your health insurance company makes that you don't agree with.
What is an appeal?
What types of decisions can be appealed to the Marketplace?
• Denial of premium tax credits or CSRs (cost sharing reductions)
• Amount of premium tax credits or CSRs (cost sharing reductions)
• Denial of eligibility to enroll in marketplace coverage
• Denial of a special enrollment period (SEP)
• Termination of marketplace coverage
Health Insurance Appeals
- a doctor was listed as in-network, but when you try to see them, the provider doesn’t accept your insurance
- you went to the emergency room and the your bill says the provider was out-of-network and you owe money
- the insurer denied a claim for a covered service or procedure
In these situations, the first step is to contact your insurance company to find out how to file an appeal. You can look at your insurance card for the customer service phone number. Most appeals need to be filed within 180 days of receiving a claim denial or decision you don’t agree with.
For more information on how to file an insurance company appeal, go here.
If you don’t agree with the insurer’s decision, you can also ask for an external review to have an independent 3rd party review your case.
Need More Help?
If you need help filing an appeal or have any other questions about your insurance and your appeal rights, you can contact the Illinois Department of Insurance, Office of Consumer Health Information (OCHI): (877) 527-9431