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]