If you are a Rhode Island resident, you can file a complaint with the Rhode Island Department of Business Regulation, Insurance Division, if your claim is denied after the external review process and you believe that your health insurer has done something illegal or unethical.

Complaint information. Your complaint should include the following information:

• The name, address, email address, and telephone number of the person making the complaint (“Complainant”);
• The name of the insured individual;
• The names of other parties involved in the dispute;
• The name of the insurance company, insurance agency, and agent, adjuster, or appraiser;
• The policy number, certificate number, claim number, and date of loss;
• The type of insurance and reason for complaint; and
• The details of your complaint.^[17]

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

• A copy of your insurance card;
• Copies of the determination letters 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.^[18]

How to submit. The complaint may be submitted online here, faxed to (401) 462-9602, emailed to [email protected], or mailed to the following address:

State of Rhode Island and Providence Plantations
Department of Business Regulation
Insurance Division
1511 Pontiac Avenue, Bldg. 69-2
Cranston, RI 02902^[19]

Note that the Insurance Division does not have the authority to require an insurer to pay a claim.^[20] If your case involves failure of your health insurer to pay your claim, you should contact the Rhode Island Insurance Resource, Education, and Assistance Consumer Helpline (“RI REACH”) at (855) 747-3224 to file a complaint. A representative of RI Reach will be able to assist you through the process.