If you are a West Virginia resident and your insurer denies your coverage after the external review process, you can file a complaint with the West Virginia Offices of the Insurance Commissioner Consumer Services Division (“Division”).

Complaint information. You can find a copy of the complaint form here. 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 patient and name of the insured, if different than the Complainant;
• The names of other parties involved in the claim;
• The name of insurance company;
• The type of coverage, policy number, claim number, and date of loss;
• The details of the complaint; and
• What you consider to be a fair resolution.^[14]

Supporting documents. You should submit the following supporting documents with your complaint:

• 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.^[15]

How to submit. The complaint and supporting documents can be faxed to (304) 558-4965 or mailed to the following address:

Consumer Services Division
West Virginia Offices of the Insurance Commissioner
P.O. Box 50540
Charleston, WV 25305-0540^[16]