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]