If you are a Pennsylvania resident and your claim is denied after the external review process, you can file a complaint with the Department.

Complaint information. A copy of the complaint packet can be found here. 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, if different than the Complainant;
• Insurance identification number;
• The type of insurance;
• The type of problem;
• The name of the insurance company;
• Policy number, claim number, and date of loss;
• The state in which the policy was sold;
• Brief description of the issue; and
• What you consider to be a fair resolution.^[14]

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

• A signed medical record release form (included with the complaint packet);
• A copy of your insurance card;
• Copies of coverage 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.^[15]

How to submit. The complaint may be submitted online here, by fax to (717) 787-8585, or by mail to the following address:

Pennsylvania Insurance Department
Bureau of Consumer Services
Room 1209, Strawberry Square
Harrisburg, PA 17120^[16]