If you are a Wisconsin resident and your claim is denied after the external review process, you can file a complaint with the Wisconsin Office of the Commissioner of Insurance (“Office”).
Complaint information. 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 than the Complainant;
- The name of your employer;
- The name of the insurance company;
- The state where the insurance plan was purchased;
- The policy/certificate number, claim number, type of insurance, and date of loss;
- The details of the complaint; and
- What you consider to be a fair resolution.
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.[14]
How to submit. The complaint and supporting documents may be submitted online here, faxed to (608) 264-8115, or mailed to the following address:
Office of the Commissioner of Insurance
P.O. Box 7873
Madison, WI 53707-7873
If you are sending your complaint by FedEx, UPS, or overnight mail, you should send it to the following address:
Office of the Commissioner of Insurance
125 South Webster Street
Madison, WI 53707-3474[15]