If your plan is a "self-funded" benefit plan offered by an employer or bona fide union trust under a union contract, state insurance departments have no jurisdiction. Instead, you may file a complaint with the US Department of Labor Pension and Welfare Benefits Administration at 617-565-9600.
If you are uncertain which type of benefit plan you have i.e., fully insured, self-insured, or self-funded you should contact your human resource department or your insurance carrier for clarification.
If your health plan is self-funded but offered through a government or church employer, follow the appeals procedures outlined in your benefit booklet and or other plan documents.In most cases ultimate responsibility for resolving these disputes rests with the governing body of the employer sponsoring the plan. You should contact your employer’s human resources department for more information.
If you have a disability, you may have certain protections available under the Americans with Disabilities Act (ADA) that applies specifically to self-funded coverage. You can reach the ADA Technical Assistance Center at 1-800-949-4232 or the US Department of Justice (American Disabilities Act Division) at 1-800-514-0301 (voice) or 1-800-514-0383 (TDD).