How and When to Submit a Complaint to the Kentucky Department of Insurance as a Provider (and When Consumers Should Too)

If you are in network with insurance payers, navigating insurance issues can be challenging. When delays, non-responses, or violations begin affecting your ability to care for clients or run your business, it may be time to file a formal complaint with the Kentucky Department of Insurance (DOI). The DOI oversees insurance companies to ensure they follow state law, including prompt pay and fair credentialing requirements.

When Providers Should Consider Filing a DOI Complaint

You may consider filing a DOI complaint when:

• Claims are repeatedly unpaid, underpaid, or “pending” without clear justification

• Insurers fail to respond to provider inquiries within reasonable or required timeframes

• You can’t get clarification on unclear or contradictory EOBs

• Provider relations or appeals have been exhausted without resolution

• Credentialing is significantly delayed beyond Kentucky’s expected timelines

• An insurer appears non-compliant with prompt-pay laws or credentialing regulations

• Contracting issues (e.g., stalled negotiations or sudden terminations) seem unlawful or retaliatory

Before filing, always document your attempts to resolve the issue—communication logs, dates, emails, claim numbers, and submitted credentialing materials.

Credentialing Timelines in Kentucky

Although payers differ slightly, Kentucky generally expects insurers to follow these standards:

• 30 days to acknowledge receipt of a credentialing application

• 90 days to issue a credentialing decision, barring external delays

If your application sits for months without updates, or the insurer repeatedly restarts the process, this is appropriate grounds for a DOI complaint.

How to Submit a Provider Complaint

1. Gather your documentation Include claim numbers, client initials (never full PHI), dates of service, correspondence, and credentialing submission dates.

2. Submit through the Kentucky DOI online complaint portal Upload supporting documents and clearly describe the issue.

3. Choose “Consumer Complaint” and NOT "Provider Complaint" -- I know this is confusing but trust me.

4. Respond to any DOI follow-ups to keep your case moving.

5. Allow time for investigation as the DOI reaches out to the insurer.

When It May Be a Good Idea for Consumers to Submit a Complaint Too

Consumers (your clients) also have the right to file a DOI complaint when they believe their insurance company is not acting in compliance with Kentucky law. This can help support what you are experiencing on the provider side, especially when patterns emerge.

Consumers may consider filing a complaint when:

• Their claims are denied without clear, lawful, or clinically supported reasons

• They experience unreasonable delays in claims processing or prior authorizations

• Their insurer refuses to cover services that should be included per their plan

• They are unable to get clear information about benefits, deductibles, or authorizations

• They believe they are being charged incorrectly, including surprise billing

• Network adequacy issues limit access to care (e.g., no local providers accepting their plan)

• Mental health parity violations appear to be occurring (stricter limits on mental health vs. medical care)

Consumers should also save documentation such as EOBs, denial letters, phone logs, and policy details.

When both provider and consumer complaints are filed regarding the same insurer behavior, the DOI gains a clearer picture of systemic issues affecting Kentuckians.

Why Submitting Complaints Matters

Filing a DOI complaint isn't just about resolving a single issue—it helps:

• Hold insurers accountable

• Document repeated violations or patterns

• Ensure Kentucky insurance laws are being followed

• Protect access to behavioral health care statewide

Your complaint may resolve your immediate concern, but it also contributes to broader system improvement for both providers and clients.