If you are a resident of the District of Columbia and your claim is denied after the external review process, you can file a complaint with the Department of Insurance, Securities and Banking (“Department”).

Complaint information.

You can find 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 insured, if different than the Complainant;
  • The name, address, and telephone number of insurance company;
  • The name and title of any person you’ve spoken with about your claim at the insurance company as well as the date and place;
  • Policy number, group name or number, claim number, date of coverage, and date of loss;
  • The details of the complaint; and
  • What you consider to be a fair resolution.[15]

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.[16]

How to submit.

You can submit your complaint and the supporting documents online here, by faxing them to (202) 354-1085, by emailing them to [email protected], or my mail or hand delivered to the following address:

District of Columbia Department of Insurance, Securities, and Banking
Attn: Consumer Services Division
810 First Street, NE, Suite 701
Washington, DC 20002[17]