If you are an Alabama resident and you have completed the external review processes but still lack access to a treatment, you can file a complaint with the Alabama Department of Insurance (“Department”). Your complaint should include the following information:
- The name, address, email address, and telephone number of the person filing the complaint (“Complainant”);
- The name of the insured individual, if different from the Complainant;
- The names of any other parties involved in the claim (for example, the plan administrator);
- The name of insurance company and the type of insurance;
- The state where the insurance plan was purchased;
- Claim information, including the policy number, certificate number, claim number, dates of denial, and amount in dispute;
- The reason for and details of the complaint; and
- What you consider to be a fair resolution.
You should also submit the following documents as supporting information:
- A copy of your insurance card;
- Copies of coverage denials or adverse benefit determinations from your insurer;
- Copies of any determinations made by internal and external reviewers;
- Any materials submitted with prior appeals and complaints;
- Supporting documentation from your health care provider;
- A copy of your insurance policy; and
- All responses from your insurer.[9]
The complaint may be submitted online at: https://sbs-al.naic.org/Lion-Web/servlet/org.naic.sbs.ext.onlineComplaint.OnlineComplaintCtrl?spanishVersion=N, faxed to (334) 956-7932, or mailed to the following address:
Alabama Department of Insurance
Consumer Services Division
P.O. Box 303351
Montgomery, AL 303351[10]