Who should I call if I have any questions about filing a complaint?

You can contact the Pennsylvania Attorney General’s Office, Health Care Section at (717) 705-6938 or (877) 888-4877. The Office is open from 8:30 a.m. to 5:00 p.m. Monday through Friday. You can contact the Pennsylvania Insurance Department at (877) 881-6388....

What happens after the Office of Attorney General receives my complaint?

Once the Office receives your complaint, a Health Care Section agent will determine if the Office is the most appropriate agency to address your concern.[21] If so, the agent will forward a copy of your complaint to your health insurer. Your...

How do I file a complaint with the Pennsylvania Attorney General’s Office?

If you are a Pennsylvania resident and your claim is denied after the external review process, you can file a complaint with the Office. A copy of the complaint packet can be found here. Complaint information. Your complaint should include the following...

What happens after the Insurance Department receives my complaint?

Upon submitting your complaint, you will receive a complaint identification number.[17] The Department will forward a copy of your complaint to your health insurer, who has 15 days to respond. The process generally takes up to a month to complete. In...

How do I file a complaint with the Pennsylvania Insurance Department?

If you are a Pennsylvania resident and your claim is denied after the external review process, you can file a complaint with the Department. Complaint information. A copy of the complaint packet can be found here. Your complaint should include the following...

Should I file my complaint with the Insurance Department or Attorney General’s Office?

If you are a Pennsylvania resident and your claim is denied after the external review process, you can submit a complain to either the Pennsylvania Insurance Department (“Department”) or Pennsylvania Attorney General’s Office (“Office”). Both the Department and the Office...

How long will the external review process take?

The external review process should take no more than 45 days from the date the external review organization receives your request.[12] If you request an expedited external review, the process should take no longer than 72 hours after your request is...

How do I request an external review?

You should submit your request for an external review to your health insurer within four months from the date that your insurer sent you the final decision.[8] Upon receipt of your request for external review, your health insurer will assign your...

In which circumstances can I apply for an external review?

During an external review, an independent third party reviews your insurer’s decision.[5] Your insurer will no longer have the final say over whether to approve a treatment or pay a claim. Under Pennsylvania law, you are entitled to request an external...

How long should the internal appeals process take?

The internal appeals process should take a maximum of 30 days if you have not yet received the requested service or treatment and a maximum of 60 days if you have received the service or treatment but are waiting for...

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