Where to get free help, by coverage type

Start by working out who regulates your plan, because that decides who can help for free. The answer is different for a job-based plan, a Marketplace plan, Medicare, Medicaid and military coverage. Use the map below, then add a nonprofit or legal aid if you want more.

What this means

A regulator is the government office that makes sure a plan follows the rules. Some plans answer to a state, some to the federal government. A state insurance office can help with a plan sold by an insurance company in your state. For a plan that an employer pays for itself (a self-funded plan), state insurance law generally cannot be applied, so the federal Department of Labor is the helper to call. If you are not sure which you have, see how to find out your plan type or use the coverage type finder.

Who to call, by coverage type

• Job-based plan paid by the employer itself (self-funded). The Employee Benefits Security Administration, part of the Department of Labor, takes calls on 1-866-444-3272 and online. A benefits advisor can explain your rights and next steps. See help from the Department of Labor.
• Job-based plan bought from an insurance company (fully insured), Marketplace and other individual plans. The state insurance department handles complaints about insurers. Your state’s consumer assistance program, if it has one, can help, and HealthCare.gov says it can file an appeal for you. Your denial notice from a plan that is not grandfathered must list the contact for any state consumer assistance program. See what a state consumer advocate does.
• Government employer plans and federal employee plans. A self-funded plan run by a state or local government answers to the Centers for Medicare & Medicaid Services. Federal Employees Health Benefits plans answer to the Office of Personnel Management.
• Medicare. A State Health Insurance Assistance Program gives free, one-on-one counseling and is not connected to any insurance company. Find yours at shiphelp.org or 877-839-2675. 1-800-MEDICARE (1-800-633-4227; text telephone 1-877-486-2048) can also help. See Medicare counseling.
• Medicaid and children’s coverage. The state Medicaid agency must tell you in writing about your right to a fair hearing, how to ask, and your right to be represented. Legal aid offices help with Medicaid problems. Our state pages list the agency and legal aid where we have them.
• Military and veterans. At a Department of Veterans Affairs medical facility, the patient advocate is a staff member whose job is to help resolve concerns and to help file a clinical appeal. TRICARE appeals start with your regional contractor. The TRICARE appeals page, listed under sources, has the steps.

What to do

1. Find your notice and its date. The date on your notice, which controls, sets your deadline. Calling a helper does not pause it.
2. Pick the row above that matches your coverage. If you have two plans, start with the helper for the plan that denied the claim.
3. Call or write with the facts ready (your step). Have your denial letter, member number, claim number, the deadline and what you want to happen. The call script for the regulator helps.
4. Ask each helper the same questions. What can you do for me? What do you need from me? When will I hear back? Write down names and dates in your call log.
5. Add a nonprofit or legal aid if you want a person to do more. The Patient Advocate Foundation offers free case management to eligible patients, with a daily cap on new cases. Triage Cancer offers free calls with a team described as trained attorneys, with no legal representation. See legal aid and paying for help.
6. Use the local list. The find help tool shows the helpers for your state and coverage.

The rule

Complaints about a private employer plan go to the Employee Benefits Security Administration on 1-866-444-3272 or its online form. Complaints about an insurance company or an insured policy go to the state insurance department. See the Department of Labor booklet and HealthCare.gov.

Watch for

• Capacity. Free programs have limits on hours, on cases per day and on who qualifies. If one cannot take you, ask where to go next and try another.
• Numbers and hours change. Confirm a number on the official page before you call.
• Wrong helper. A state insurance office may tell you it cannot help with a self-funded employer plan. Then call the Department of Labor.
• A complaint is not an appeal. Do both if you can. See appeal, complaint, grievance and external review.

What next

• What a state consumer advocate does: a closer look at the free state programs.
• Legal aid and when to hire a lawyer: when a lawyer is the right helper.
• Find free help: all the pages on this topic.