If you are a Pennsylvania resident and your claim is denied after the external review process, you can file a complaint with the Office. A copy of the complaint packet can be found here.

Complaint information. Your complaint should include the following information:

• The name, address, email address, and telephone number of the person filing the complaint (“Complainant”);
• The name, address, email address, and telephone number of the person on whose behalf complaint is being filed, if different than the Complainant;
• The name of the insured;
• The name, address, and telephone number of insurance company;
• The policy number, group number, and type of insurance;
• The name, date of birth, and relationship to insured of the patient;
• The details of the complaint; and
• What you consider to be a fair resolution.^[18]

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

• A signed medical record release form (included with the complaint packet)
• A copy of your insurance card;
• Copies of 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 doctor;
• A copy of your insurance policy; and
• All responses from your insurer.^[19]

How to submit. The complaint may be submitted online here, by email to [email protected], or by mail to the following address:

Office of Attorney General
Health Care Section
14^th Floor, Strawberry Square
Harrisburg, PA 17120^[20]