Guidelines for Filing Complaints from Providers about Health Claim Payments
TDI regulates HMO and fully insured health plans, which represent less than a quarter of the health insurance sold in Texas. Providers and their third-party billing services with complaints about health claim payments should follow these guidelines:
- Complain to the appropriate agency. If the patient’s ID card says "TDI" or "DOI" in the lower right corner, complain to TDI. For complaints about other types of health plans, contact the appropriate agency for help. To contact other agencies for help, visit Physician/Provider Information and Advice for Physicians and Providers – Resources.
- For multiple claims, please use the Health Insurance Provider Complaints template. Also, please be sure to do the following:
- Submit claims for only one health plan per template. Use a separate template for each health plan.
- Include information for up to 10 claims on the template.
- Fax or email the template to TDI:
- Fax to 512-490-1007
- Email to ConsumerProtection@tdi.texas.gov
For more information, contact:
Last updated: 10/03/2016