Services for Consumers - Health Insurance

Medical Appeals

Contact Smart NC:

  • 855-408-1212 (toll free)
  • 919-807-6865 (fax)
To view information related to Medical Appeals, select a subject from the drop-down list.

The North Carolina Department of Insurance developed Health Insurance Smart NC (Smart NC) to help North Carolinians better understand their options and rights related to health insurance. Smart NC provides consumer counseling on utilization review and appeals issues and assists consumers with resolving coverage disputes with their health insurance company. Services are provided at no cost to you.

Smart NC can help you:

  • Understand the appeals process and explain your rights under NC state law.
  • File your medical appeal with your health insurance company.
  • Request an external review if your health insurance claim was denied.

For consumers covered under self-funded plans, we will assist with complaint resolution to the extent allowed; however the Department of Insurance has no jurisdiction is these cases.