If you are a Washington resident and your claim is denied after the external review process, you can file a complaint with the Washington Office of the Insurance Commissioner (“Office”).

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 insured individual, if different than the Complainant;
• The name of insurance company;
• Policy number, claim number, type of policy, and type of insurance;
• The name, company name, address, and telephone number of the insurance adjuster;
• Type of problem;
• The details of the complaint; and
• What you consider to be a fair resolution.^[15]

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

• 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.^[16]

How to submit. The complaint may be submitted online here, faxed to (360) 586-2018, or mailed to the following address:

Washington State Office of the Insurance Commissioner
P.O. Box 40255
Olympia, WA 98504-0255^[17]