If you are Florida resident and your insurer denies your coverage after the external review process, you can file a complaint with the Florida Division of Consumer Services (“Division”). You should have the following information available when filing your complaint:

  • 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 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.[10]

You may submit the complaint electronically along with supporting documents here. Alternatively, you can call in your complaint to (877) 693-5236 (in-state) or (850) 413-3089 (out-of-state). You can also email your complaint and supporting documents to [email protected].[11]