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]