Filing Complaints Against Health Plans Not Regulated by DCI

The Missouri Department of Commerce & Insurance (DCI) handles thousands of health insurance complaints every year. However, not all health plans fall under our jurisdiction. This reference page provides contact information for plans not regulated by DCI, so you know who to contact when you need assistance. 

Medicare

The U.S. Department of Health and Human Services (Centers for Medicare & Medicaid Services) has jurisdiction over Medicare claims issues, including Medicare Advantage plans. 

However, if you have a question or complaint about a Medicare product, you may contact the Missouri SHIP program at 800-390-3330 or www.missouriship.org/.

MO HealthNet & MO HealthNet for Kids (Medicaid)

  • Missouri Department of Social Services
    Mo HealthNet Participant Services Unit
    800-392-2161
    573-751-6527
    http://dss.mo.gov  

Government Employees

Federal Employees:

  • Federal Employee Benefit Plans (includes postal workers)
    U.S. Office of Personnel Management
    Agency Employee Review
    Retirement and Insurance Group
    1900 E. St. NW
    Washington, DC 20415-1000
    202-606-1800
    http://www.opm.gov/

State Employees

Missouri Consolidated Health Care Plan (MCHCP)

PO Box 104355
Jefferson City MO 65110-4355
Office Location: 832 Weathered Rock Court
Jefferson City MO 65101
800-487-0771
573-526-4771 FAX
573-573-526-3033 TDD

Missouri Department of Transportation and Missouri State Highway Patrol
(Dental and vision coverage is handled through MCHCP)
MoDOT Central Office
105 West Capitol Avenue
Jefferson City, Missouri 65102
877-863-9406
Health Coverage Information:  https://www.modot.org/medical-plan

Missouri Department of Conservation
(Dental and vision coverage is handled through MCHCP)
The Conservation Employee’s Benefits Plan Trust Fund
2901 W. Truman Boulevard
P.O. Box 507
Jefferson City, Missouri 65102-0507
573-751-4115
Health Coverage Information:  http://healthlink.com/home_participant.asp

University of Missouri Systems

Columbia, system & hospital campus
(Dental plan is self funded through Delta Dental)

Faculty & staff benefits
Woodrail Centre
1000 W. Nifong, Bld. 7 – Suite 210
Columbia, MO 65211-8220
573-882-2146 (active employees)
Fax: 573-882-9603

Rolla campus
Missouri University of Science & Technology
Human Resource Services
113 Centennial Hall
Rolla, MO 65409-1050
573-341-4241
573-341-4984 FAX

Kansas City campus
U.S. Mail Address: Human Resource Dept.
226 Admin. Center
5100 Rockhill Road
Kansas City, MO 64110

Office Location: Univ of Missouri- Kansas City
Human Resource Dept.
226 Admin. Center
5115 Oak Street
Kansas City, MO 64112
816-235-1622
816-235-5515 FAX

St. Louis campus

Office Location: Human Resource Dept.
211 General Services Bldg.
U.S. Mail Address: Univ of Missouri-St. Louis
Mark Twain Drive
211 General Services Bldg.
One University Blvd.
St. Louis, MO 63121
314-516-5639
314-516-6463 FAX
http://universityofMissouri.coventryhealthcare.com/index.htm

Self-insured employee benefit plans/union plans or health and welfare plans

Many large employers provide health benefits for their employees through self-insured plans. Although self-insured plans are frequently administered by an insurance company (which explains why you carry a card from an insurance company), it is the employer and not the insurance company that ultimately pays the health claims.

Generally, federal law exempts self-insured employer plans from state insurance regulation. The same is true of health & welfare benefit plans (union plans).

If you have a health claim that is denied, we recommend you refer to your member handbook to get information on how to file an appeal under your plan as soon as possible. There are timeframes in which appeals must be filed. DCI and the Division of Consumer Affairs does have the ability to assist you in filing first- and second-level grievance and appeals with your plan administrator. Call our Insurance Consumer Hotline, 800-726-7390.

In most cases regarding compliance with either state or federal law, we will accept your complaint and attempt to obtain information from the plan. However, ultimately we will forward your complaint to the appropriate federal agency with regulatory oversight. Generally speaking, the U.S. Department of Labor has oversight of these plans and may be able to provide assistance and information to you. 

  • U.S. Department of Labor - Employee Benefits Security Administration
    Kansas City Regional Office
    1100 Main Street, Suite 1200
    Kansas City, MO 64105
    866-444-3272
    http://www.dol.gov/ebsa

Policies purchased in another state

Complaints should be sent to the Department of Insurance in the state where you purchased the policy. Check your insurance booklet or policy for the address or you can call our Insurance Consumer Hotline at 800-726-7390 for assistance.

Workers’ compensation

DCI generally does not have the authority to investigate complaints regarding workers’ compensation claims, including health provider complaints about fee schedules or claim payments. Inquiries and complaints for workers’ comp claims should be directed to:

Missouri Division of Workers' Compensation
3315 West Truman Boulevard
P.O. Box 58
Jefferson City, MO 65102-0058
573-751-4231
www.labor.mo.gov/dwc/
Toll-free information line: 800-775-2667

Dispute Management Unit
P.O. Box 58
Jefferson City, MO 65102-0058
573-526-4951

Insurance Unit (Self-Insured Employers and Groups)
P.O. Box 58
Jefferson City, MO 65102-0058
573-526-3692

Benefits Unit - Rehabilitation, and Second Injury Fund
P.O. Box 58
Jefferson City, MO 65102-0058
573-526-3505

Fraud and Noncompliance Unit
P.O. Box 1009
Jefferson City, MO 65102-1009
800-592-6003

Medical Fee Disputes and Religious Exceptions
P.O. Box 58
Jefferson City, MO 65102-0058
573-526-5610 or 573-522-2546