If you are a Massachusetts resident and your insurer still denies your claim after the external review process, you can file a complaint with the Massachusetts Division of Insurance (“Division”).

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 insurance company;
  • The state where the insurance plan was purchased;
  • The group number, certificate number, policy/ID number, claim number, and date of loss; and
  • The details of the complaint.

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.[22]

You can submit your complaint and the supporting documents by faxing them to (617) 753-6830 or mailing them to the following address:

Office of Consumer Affairs and Business Regulation
Division of Insurance
1000 Washington Street, Suite 810
Boston, MA 02118-6200[23]