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 can get help from TDI or another agency.
Complaints about Independent Dispute Resolution (IDR) requests and settlement outcomes can also be made through our complaint portal. TDI also regulates Employees Retirement System of Texas (ERS) and Teacher Retirement System of Texas (TRS) matters related to certain out-of-network claims through the IDR program.
Complain to the right agency
If the patient’s ID card says "TDI" or "DOI" on the front, or if the matter is about IDR, complain to TDI.
For complaints about other types of health plans that TDI doesn’t regulate, contact the appropriate agency for help. Visit For providers: Filing a complaint for health plans that TDI doesn’t regulate.
To find out more about mental health parity, visit How to get help with a mental health issue.
Before filing a complaint with TDI, gather this information:
- Copy of the front of the patient’s health plan ID card.
- Relevant explanation of benefits (EOBs).
- Documentation showing all appeals have been exhausted.
- Authorization documents (approved or denied).
- Important dates and timeline of the handling of claim.
- All other documentation supporting your complaint. For IDR related complaints about participation or settlements, include documentation of your efforts to resolve the matter directly with the health plan.
File a complaint with TDI
- Use our online complaint system. After answering some questions, you will need to upload supporting documents. You must upload a copy of the patient’s health plan ID card and the information you were asked to gather (above) before we can help with your complaint.
- TDI can’t help if we don’t get enough information from you. If the above information related to your complaint is missing, TDI will close your complaint. Once you get this necessary information, you can begin a new complaint in the complaint portal.
- For complaints involving more than five claims, call our Help Line at 800-252-3439 or the IDR help line at 855-839-2427 for advice.