Q: What do I do if I'm having problems with my marketplace plan?
A: If you are having problems with your marketplace plan — for example, you aren’t getting the coverage you were promised, or the plan isn’t paying your claims — you have certain rights and ways to get those problems fixed. Health plans must give you a way to report and resolve complaints, but sometimes they only give you a certain amount of time to take action. So it’s important to check your insurance paperwork and contact your health plan right away if you are having trouble. You might also have to gather some documents to show the problems you are having.
If this doesn’t help, or if your health plan is not communicating with you, you can also file a complaint with the Texas Department of Insurance (TDI).
The complaint must be in writing, and you can find the form and instructions online at www.tdi.texas.gov/consumer/complfrm.html. Then submit the complaint:
- Directly online using the complaint form:www.tdi.texas.gov/consumer/complfrm.html;
- By email: firstname.lastname@example.org;
- By fax: (512) 305-7463; or
- By mail: Texas Department of Insurance
Consumer Protection (111-1A)
PO Box 149091
Austin, Texas 78714-9091.