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]