| National
Resources |
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A Consumer Guide to Handling
Disputes with Your Health Plan (PDF)
Clearly written and comprehensive guide
from a respected independent source.
NAIC Consumer Information
Source
A resource provided by the National
Association of Insurance Commissioners, this database allows you
to research an insurance company's financial information and
obtain a report of past complaints nationwide.
How
to File a Health Information Privacy Complaint with the Office of
Civil Rights
If you believe that a person, agency or organization covered
under the HIPAA Privacy Rule ("a covered entity") violated your
(or someone else's) health information privacy rights or
committed another violation of the Privacy Rule, you may file a
complaint with the Office for Civil Rights (OCR). A complaint
form can be downloaded from this site.
Finding Your Way through the HMO Grievance and
Appeals Process, an NRH Field Guide for People with Disabilities
(PDF)
This information guide, put out by the NRH Center for Health and
Disability Research explains your rights under Medicare, Medicaid
and HMO and each ones Grievances and Appeals process, internal
and external review.
The
Kaiser Family Foundation
This Guide will help you navigate
your plan’s internal appeals procedure and your
state’s external review process for disputes with your
employer or private health plan. You cannot use this Guide,
however, for resolving disputes with your Medicare or Medicaid
health plan because these programs have their own procedures for
resolving disputes.
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|
Alabama |
|
Alabama Department of
Insurance
334-269-3550
This website offers two methods of submitting a complaint,
on-line and hard copy.
AlabamaState Board of Medical
Examiners
(334) 242-4116
The Alabama Board of Medical Examiners has jurisdiction over
investigation of complaints which are placed against medical
doctors or doctors of osteopathy. This site explains how to file
a complaint. A complaint form is provided that can be
downloaded.
|
| Alaska
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|
AlaskaDivision of
Insurance
(907) 269-7900
The Division of Insurance enforces Alaska insurance laws and
assists consumers directly by responding to insurance inquiries
and investigating complaints against insurance companies and
producers. The Consumer Services section of the Division is
located in the Anchorage office and is responsible for handling
consumer complaints and inquiries. This website instructs you as
to have to submit a complaint after receiving an unsatisfactory
response from your insurance company. This site has a complaint
form that can be downloaded.Alaska State Medical
Board
(907) 269-8163
The Alaska State Medical Board adopts regulations to carry out
the laws governing the practice of medicine in Alaska. It makes
final licensing decisions and takes disciplinary action against
people who violate the licensing laws. This website provides
contact information for the complaint investigators.
|
| Arizona
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|
A Consumer Guide to
Healthcare Appeals in Arizona (PDF)Managed Care Complaint
Ratio 2002
A brochure (PDF) listing number of
enrollees in all health plans including medical, dental, vision,
medicare supplement, and medicare + choice organized by
individual and group policies. A good resource to find out the
total number of health care plans in
Arizona.Arizona Department of Insurance
This website explains how to file an appeal and provides request
forms for health care appeals and expedited medical reviews.
ArizonaMedical
Board
The Arizona Medical Board (Board) regulates doctors of medicine
(MD) under the Arizona Medical Practice Act. A three stage
adjudication process was developed to ensure thorough
investigations, faster case resolution timeframes and opportunity
for all parties involved to provide information to the Board.
This website instructs you on how to file a complaint, provides
complaint forms and gives you the opportunity to submit the
complaint online.
|
| Arkansas
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|
How to File an Insurance
ComplaintArkansas Department of Insurance Mediation
Program (PDF)
1-800-532-5494
The Mediation Program known as EAGLE (Ending Arguments Gently
Legally Economically) is a volunteer program designed to assist
insurance consumers and insurers with conflict resolution, in
hopes of thwarting lengthy and costly litigation
proceedings.Arkansas
State Medical Board
Website explains how to file a complaint against a
Practitioner.
Filing
a Complaint with the Attorney General’s
Office
1-800-482-8982
If you are unable to resolve your complaint yourself, you may
contact the Consumer Protection Division for assistance. Your
complaint can be submitted either in writing or online. You can
obtain the appropriate form by either writing or calling the
Consumer Protection Division. You may also file a complaint
online through this website, a complaint form is provided.
|
| California |
California
Department of Managed Health Care
(888) HMO-2219
The Department of Managed Health Care regulates and licenses
Health Maintenance Organizations (HMOs) and some Preferred
Provider Organizations (PPOs) in an effort to promote quality
health care for the people of California. The Department is
responsible for ensuring health plans comply with the Knox-Keene
Health Care Service Plan Act of 1975 and providing a patient
complaint process. The Department of Managed Health Care works to
ensure high quality health care and its HMO Health Center can
help resolve problems you have with your health plan, such as
medical care, prescriptions, preventative testing, and mental
health services. Please be advised that you must first file a
complaint with your health plan before filing a complaint with
the Department of Managed Health Care.The California Department of Insurance
Independent Medical Review Board
1-800-927-HELP (4357)
An Independent Medical Review (IMR) is a process where expert
independent medical professionals are selected to review specific
medical decisions made by the insurance company. The California
Department of Insurance (CDI) administers an Independent Medical
Review program that enables you, the insured, to request an
impartial appraisal of medical decisions within certain
guidelines specified by the law. It is important to note that the
IMR process cannot be used for an insurance company decision that
is based on a coverage issue. Only decisions regarding a disputed
health care service, as it relates to the practice of medicine,
that do not involve a coverage issue are qualified for the IMR
program. This website explains what an (IMR) is and how to
request one. The California Department of Insurance Request for
Assistance
1-800-927-HELP (4357)
This website explains how to file a complaint when you have
experienced improper denial of a claim or an offer of an amount
less than that indicated by the policy, delay in settlement of a
claim, alleged illegal cancellation or termination of an
insurance policy, alleged misrepresentation by an agent, broker,
or solicitor, alleged theft of premiums paid to an agent, broker,
or solicitor, problems concerning insurance premiums and rates,
alleged improper handling of an escrow transaction by a title
insurer or underwritten title company and improper handling of a
title insurance claim. This site offers two methods of filing a
complaint, online or by hard copy.Medical Board of California
(1-800-633-2322)
The Medical Board is responsible for investigating complaints and
disciplining physicians who violate the law. If a doctor or other
Board licensee violates the laws that apply to the practice of
medicine, Board staff will investigate and appropriate charges
may be filed. Staff investigates the following type of issues:
The quality of care and treatment provided by a physician (e.g.
negligence), violation of drug laws or misprescribing, substance
abuse by the physician, sexual misconduct by the physician,
dishonesty (including filling fraudulent
insurance/Medi-Cal/Medicare claims) and the practice of medicine
by an unlicensed person. This Website provides an overall view of
the complaint process and how to file a
complaint.If Your Medicare Claim is Denied
You have the right to appeal any decision about your Medicare
services. If Medicare does not pay for an item or service, or if
you are not provided an item or service you think you should
receive, you can appeal. This website explains how and where to
file an appeal in the State of California . The California Patient’s Rights Guide, How
to File Grievances with your Health Plan
Website explains when and how to file a grievance.
Center for Health Care Rights
If you have a problem with your health plan, the rights you have
depend on the type of plan you are in and who pays for your
coverage. We encourage you to try to resolve your problem first
with your doctor, medical group, or health plan. If you are
unable to resolve your problem yourself, there are private
groups, and state and federal agencies, that might be able to
help.
|
| Colorado
|
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What Happens When Your
Health Insurer says No (PDF)
This brochure is a guide to your rights
regarding insurance pre-authorization and grievance procedures.
It details what steps to take if your health insurance plan
denies coverage for services you and/or your doctor feel are
medically necessary. Colorado Department of Insurance Complaint
Form
As a state agency, the Department of Insurance regulates the
insurance industry and assists consumers and other stakeholders
with insurance issues that are important to them. This website
gives you the opportunity to submit your complaint online.
Colorado
Board of Medical Examiners
Each year approximately 800 complaints are made against Colorado
physicians and physician assistants. The Medical Board relies on
patients and their families, medical professionals, specialty
societies and other government and law enforcement agencies to
bring to the attention of the Board specific cases where issues
of poor or questionable medical care are raised. The Board has
prepared a brochure entitled "Consumer Guide to Filing a
Complaint." This and a copy of the Complaint Form are available
on this website.
|
| Connecticut |
|
Health Care Complaints
This site provides information about the
Greater Hartford Legal Aid, which is a not-for-profit legal
services agency whose staff helps low-income clients and
individuals over 60 with civil legal issues, including fair
treatment before government agencies; and
access to food, housing, and health care.
Connecticut Department of Public
HealthNursing Home Health Care
Complaints
This site provides brief informantion on how elderly and their
families can file complaints about health care providers with the
Connecticut Department of Public Health. Complaints can be
received at the Connecticut Department of Public Health, Division
of Health Systems Regulation by calling (860) 509-7400 or by
writing. Connecticut Department of
Insurance
The Insurance Department encourages consumers who have a concern
or complaint against an insurance company or insurance licensee
to submit their concerns or complaints to the Department’s
Consumer Affairs Division. The Consumer Affairs Division requires
that you send your concerns or complaints in writing. For your
convenience, a complaint form to assist you in including all
pertinent information can be downloaded from this
website.The Consumer Guide to the
Department of Public Health’s Investigation and Hearing
Process (PDF)
Connecticut Department of Insurance External Appeal
Process
Connecticut General Statue 38a-478n, gives you the right under
specific circumstances, when you are covered by a managed care
plan, to an external appeal for coverage of medical services or
supplies denied to you by your Managed Care Organization (MCO)
through a process know as utilization review. This website
explains the internal and external appeal process and provides an
external appeal form for downloading.
|
| Delaware |
|
Delaware How to File a Complaint
How to file an insurance complaint in
DEDelaware Arbitration of Health
Insurance Claims & Internal Review of Medical Insurance
Carriers (PDF)
This document contains many references to state laws and
regualtions, and is written from a legal perspective. It provides
"the procedures for the arbitration of certain claims for
benefits available under health insurance policies or agreements,
and/or the explicit provisions of the statutes under which this
regulation is promulgated."Resolving Health Insurance Disputes | An
Action Kit for Delaware (PDF)
This action kit will provides assistance from the Insurance
Department in resolving a conflict with your insurance company or
agent. It explains your rights and responsibilities as a
policyholder and where to turn for help, also how to file a
claim.
Delaware Department of Insurance
Online Complaint/Inquiry Form
This site
gives you the opportunity to submit your complaint/inquiry
online. Before you file a complaint/inquiry with the Delaware
Department of Insurance, you should first contact the insurance
company, agent or adjuster in an effort to resolve the issue(s).
If you do not receive a satisfactory response, then complete this
form. Delaware Department of Insurance Complaint/Inquiry Form
(PDF)
This site gives you the opportunity to download a
complaint/inquiry form to submit as a hard copy. Before you file
a complaint/inquiry with the Delaware Department of Insurance,
you should first contact the insurance company, agent or adjuster
in an effort to resolve the issue(s). If you do not receive a
satisfactory response, then complete this form.
Delaware
Board of Medical Practice
Complaints can be filed with the Board of Medical Practice. They
must be in writing, signed and include an address and phone
number for the complainant. They must also include the name and
location of the professional who is the subject of your complaint
and sufficient facts giving the details of your complaint. This
website explains how to file a complaint, the complaint process
and its possible outcome. This site also provides a complaint
form to download.
|
| District of Columbia
|
Washington DC Department of Insurance: Filing a
Complaint
The DC Department of Insurance offers 2
methods of filing a complaint, online or in hard copy. Visit the
site for all the information or contact the Manager of Consumer
Services at (202) 727-8000.
Health Benefits Plan Appeal
This Department of Health Website explains your rights and what
actions you must take for appealing a Health Benefits Plan's
decision about your coverage.
|
| Florida
|
Agency for Health Care Administration,
Bureau of Managed Health Care
The HMO/Managed Care Hotline responds to emergency or urgent
quality of health care
complaints or concerns from members of the following managed care
organizations (MCOs) Statewide Provider and Subscriber
Assistance Program
The
Statewide Provider and Subscriber Assistance Program (SPSAP) is a
State of Florida program designed to assist consumers of managed
care entities, such as Health Maintenance Organizations, Prepaid
Health Clinics, Prepaid Health Plans, and Exclusive Provider
Organizations, with grievances that have not been satisfactorily
resolved. Information regarding this program can be found under
the “How it Works” and “FAQ” links at the
top of the page, and forms for filing a grievance can be
downloaded via the “Forms” link.A Consumer's Guide to the
Complaint Process
(888) 419-3456
How to file a complaint about a health care
practitioner in Florida. Complaint form available on-line in pdf
format or by calling the above number.
Florida Department of Health, Division of Medical
Quality Assurance
1-888 419-3456
Florida Department of Health, Division of Medical Quality
Assurance is responsible for analysis of complaints and reports
involving potential misconduct of a licensee and initiates
investigations when appropriate. If the Department determines
that your complaint is a possible violation of Florida Law, it
will be investigated. A Department investigator may contact you
for additional information. Following legal review, the
Department will refer the complaint to the appropriate panel of
the regulatory board to determine if a violation of the Florida
Law has occurred. This website provides complaint forms regarding
general health care, dental, psychiatric, psychology
professionals and unlicensed persons related to the medical
professions. The site explains how to file a complaint and the
complaint process.
|
| Georgia
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|
Georgia
Insurance and Fire Safety Commissioner (Complaint about
HMO/PPO)
If you want to complain about how a Health Maintenance
Organization (HMO) or Preferred Provider Organization (PPO)
processed your claim or if you have an underwriting issue such as
an underwriting denial or classification change this site
provides the opportunity to file the complaint
online.Georgia
Insurance and Fire Safety Commissioner (Complaint about Group
Health Insurance)
Depending on your policy, Group Health Insurance can cover you
for dental, medical, disability and accidental expenses. Select
this option if you have a complaint about how your group health
insurance company handled your claim or underwriting issue.This
site provides the opportunity to file the complaint online.
Georgia
CompositeState Board of Medical Examiners
(404) 656-9313
The Composite State Board of Medical Examiners (Medical Board) in
its effort to protect the integrity of the complaint process as
well as the Georgia health care consumer, accepts written, signed
and dated complaints as provided on this website in a
downloadable format or by calling the Medical Board's offices.
This site provides you with the information on how to make a
complaint against a physician, a physician's assistant, an
acupuncturist, an auricular detoxification specialist, or a
respiratory care professional. This site also provides answers to
FAQ.
|
| Hawaii
|
|
Hawaii Department of Commerce and Consumer
Affairs, Insurance Division
The Insurance Division oversees the Hawaii insurance industry;
issues licenses, examines the fiscal condition of Hawaii-based
companies, reviews rate and policy filings and investigates
insurance related complaints. When a complaint is filed with the
Insurance Division, the Compliance and Enforcement Branch
conducts an investigation to assure compliance with the
applicable statutes and rules. Appropriate disciplinary actions
are taken by the Compliance and Enforcement Branch when
necessary. If it is determined that a case warrants prosecution,
it is referred to the Office of the Attorney General for
prosecution by the State. To file a complaint, a complaint form
must be filled out and submitted to the Hawaii Insurance
Division. This site provides a complaint/inquiry form to
download.Hawaii Department of Commerce and
Consumer Affairs, Insurance Division (External and Expedited
Review)
An external review is the process by which an independent review
is made of a decision made by the enrollee’s managed care
plan. Expedited reviews may be authorized if it is determined
that the standard review time frame may: seriously jeopardize the
life or health of the enrollee; seriously jeopardize the
enrollee’s ability to gain maximum functioning; or subject
the enrollee to severe pain that cannot be adequately managed
without the care or treatment that is the subject of the
expedited review. This site explains the two processes and how to
file each review.
Hawaii Department of Commerce and
Consumer Affairs, Regulated Industries Complaints Office (RICO),
Health Care Provider Complaint Form (PDF)
|
| Idaho
|
|
Idaho Department of Insurance
Consumer Assistance
The Department of Insurance's Web page for consumers. It contains
links to information about your rights, the appeal process, and
publications about navigating the system.
IdahoBoard
of Medicine
Idaho laws requiring licensure or registration exist to protect
the public health by assuring the competence of professionals
practicing in the state. The Board investigates an
applicant’s background and qualifications before a
permanent license is issued. The Board takes action when
violations of the practice act can be proven. Complaints need to
be written and signed. The Board acknowledges receipt, initiates
review and opens a case file. This website explains how to file a
complaint and there is a complaint form available to
download.
|
| Illinois
|
Illinois Department of
Insurance
If you are covered by an HMO and have a complaint, you should
file an appeal directly with the HMO. If your HMO appeal for
medical services is denied, you, your designee, your primary care
physician or other health care provider can request an external
independent review through the HMO. Your request should be made
in writing unless your situation is urgent and requires an
expedited decision. You have the right to jointly approve the
doctor who will conduct the external independent review. If you
are unsure about the external independent reviewer's
qualifications, you should consult with your physician. If you
are unable to resolve a problem with your HMO or any other health
care plan, you may file a complaint at any time with the Illinois
Department of Insurance. If you would like the Department of
Insurance to investigate your complaint against an insurance
company, producer or insurance agency, this website provides a
consumer complaint form which can be completed either
electronically or hard copy format. This site also explains the
complaint process. Illinois Department of Insurance
- Where to file Medicare, Medicaid and other Health Plan
Complaints
The Department of Insurance handles thousands of health insurance
and HMO inquiries and complaints every year. However, not all
health plans fall under their jurisdiction. This site provides
information regarding plans that are not regulated by the
Department.
Illinois Department of Professional
Regulation
(312) 814-6910
Complaints against any individual or entity regulated by the
Department of Professional Regulation may be filed by contacting
the Complaint Intake Unit. This site provides you with the
opportunity to submit the complaint online. You may also send a
copy by mail to the Department of Professional Regulation,
Complaint Intake Unit, 100 West Randolph Street, Suite 9-300,
Chicago, IL 60601
|
| Indiana
|
|
Indiana
Department of Insurance
If you've tried unsuccessfully to resolve a claim problem with
your company or agent, contact the Indiana Department of
Insurance. Very often, companies will resolve disputes after the
Department intervenes on a consumer’s behalf. A formal
complaint form is not essential however; every request for
Department assistance must be in writing. This website provides
an online complaint form. Indiana Department of Insurance Health Insurance
Consumer Action Guide Resolving Health Care Insurance
Disputes
This website will help you understand how health insurance works
and what you can do to protect yourself in a dispute with a
health insurer. Information on how to contact the Indiana
Department of Insurance appears at the end of this page.
Indiana Health Professions
Bureau
The Health Professions Bureau (HPB) liscenses health care
professionals and its respective boards discipline practitioners
when necessary.
Indiana Attorney General’s
Office
A complaint form is provided to either download a hard copy or to
submit online.
|
| Iowa
|
Iowa Department of
Insurance
The Iowa Insurance Division (IID) protects consumer interests and
grants companies permission to sell insurance in Iowa. This
website gives tips on how to resolve your dispute with your
insurance company. If your dispute is unable to be resolved to
your satisfaction, this site also explains how to file a
complaint with the IID and provides a complaint form to download.
This site also offers you the opportunity to submit your
complaint online.
The Iowa
Board of Medical Examiners
The Iowa Board of Medical Examiners (IBME) is authorized by
statute to investigate complaints and reports about licensees
under its jurisdiction and to take appropriate disciplinary
action against any licensee found to be in violation of state law
or Board administrative rules governing the practice of medicine
and surgery, osteopathic medicine and surgery, osteopathy and
acupuncture in Iowa. This website explains the complaint process
and provides the opportunity to either download a complaint form
or to submit one online.
|
| Kansas
|
|
Kansas Insurance Department
This website provides a complaint form that can be submitted
online.
The KansasState
Board of Healing Arts
(785) 296-7942
The Kansas State Board of Healing Arts is comprised of 15 members
appointed by the governor, 12 of whom are licensees, three of
whom are members from the general public. The Board licenses or
registers 13 health care professions. The mission of the Board is
to protect the public by requiring those professionals to meet
and maintain certain qualifications and standards of conduct. The
Board does not have disciplinary jurisdiction over other health
care professions, hospitals, and other health care facilities.
When a complaint is received by the Kansas State Board of Healing
Arts, staff for the Board makes an initial determination: the
complaint must pertain to the practice of one of the professions
regulated by the Board, and must allege facts constituting a
violation of the laws administered by the Board. These two
requirements are necessary to open a case for investigation. A
complaint form can be downloaded from this website.
|
| Kentucky |
Kentucky Consumer Protection and
Education
Kentucky Guide to Health
Insurance Appeals
Kentuckians who are enrolled in health
benefit plans have expanded appeal rights under insurance laws.
You have the right to appeal an insurer’s decision to deny
access to a treatment, service, drug or device. This document is
provided by the KY Department of Insurance.
Kentucky 2001/2002 Complaint Ratio
Search
The Complaint Ratio measures the total
number of justified complaints against every $1 million of
premiums sold in Kentucky by an insurance company during a
calendar year. For example, if a company has a ratio of 1.25, it
means that the company had 1.25 justified complaints for every $1
million premium sold. If a company has a ratio of 0, then no
complaints were filed against that company. The less complaints,
the more satisfied it’s consumers were.
KentuckyBoard
of Medical Licensure
502-429-8046
This website gives you information on how to file a grievance
with the Board and answers some FAQ.
|
| Louisiana
|
|
Medical Necessity Review Organizations in
Louisiana
Click on left side on Consumers, then choose "Click here to
conduct a search for agent, company or liscense information, then
scroll down and choose Medical Necessity Review Organization
(MNRO) Address List. Louisiana Department of
Insurance
1-800-529-5300
The Department of Insurance has made the complaint report
available to download straight from their website with the use of
a free viewing program. Or, call the statewide toll-free number,
1-800-259-5300, or, outside Louisiana, call (225) 342-5900 to
request a free copy of the complaint form. This site explains how
to submit a complaint and the complaint process.
LouisianaState Board of
Medical Examiners
This website explains the procedures for how to file a complaint
and provides a complaint form for downloading. Although it is not
necessary to use their form to make a written complaint, a
written complaint is necessary for them to initiate an
investigation.
|
| Maine
|
|
MaineBureau
of Insurance
1-800-300-5000
This website provides information on how to file a complaint and
the complaint process. You are also given the opportunity to
download a complaint form or send it electronically through this
site.
MaineBoard of
Licensure in Medicine
(888) 365-9964
This website explains the Board’s complaint process. You
must put your complaint in writing. A complaint form can be
downloaded from this site or you may submit the complaint form
electronically. Receipt of your complaint will be acknowledged by
Board staff. Your complaint will be reviewed to determine that it
is a complaint over which the Board has jurisdiction.
|
| Maryland |
|
Report on Health Care
Appeals and Grievance Law (PDF)
This document is a comprehensive report on
Health Care Appeals and Grievances for the past year. It includes
reports on how many complaints per company and other useful
information. Maryland Attorney
General: Filing a Complaint
The Health Education and Advocacy Unit of
the Consumer Protection Division of the Attorney General of
Maryland helps consumers resolve billing disputes with hospitals,
doctors, insurance companies and other health care providers.
They also help consumers negotiate refunds for medical equipment
that is defective or was never delivered, and seek repairs for
medical equipment and other health care products. For more
information, call the Health Advocacy hotline:
(410) 528-1840 Maryland Office of Health Care: Quality Consumer
Page
This site offers a reference guide to where
to file complaints for specific instances, such as nursing homes,
hospitals, or HMO.
Maryland Department of Insurance Appeals and
Grievances
1-800-492-6116
A law that took effect January 1, 1999, gives Maryland consumers
the right to appeal a decision that denies you coverage for
medically necessary treatment. If your doctor has determined that
certain medical treatment is needed, but your HMO or health
insurer does not agree, this law allows you to appeal. Under the
appeals and grievances law, the Maryland Insurance Commissioner
has the authority to overturn your health plan's decision if your
treatment is determined to be medically necessary. This website
will explain have to file a grievance and appeal and its process.
You may also download a grievance and appeal form or you may file
a grievance and appeal online through this site.
Maryland Department of Insurance
Complaint
The primary role of the Maryland Insurance Administration is to
protect consumers from illegal insurance practices by ensuring
that insurance companies and producers that operate in Maryland
act in accordance with State insurance laws. They are here to
assist you with your insurance inquiry or complaint about health,
life, property and casualty insurance. This website explains how
to file a complaint and the complaint process. All complaints
must be received in writing. If your complaint involves the
denial of coverage of health care services because the services
were deemed unnecessary treatment, please refer to the Grievances
and Appeals Process also on this site.
Maryland Department
of Health and Mental Hygiene Board of
Physicians
The Maryland Board of Physicians (the "Board") is an agency of
the state with the authority to license physicians and other
health care providers such as physician assistants, medical
radiation technologists, radiation oncology therapy
technologists, nuclear medicine technologists, respiratory care
practitioners, and psychiatrist assistants to practice in
Maryland, and to discipline licensees who violate the Maryland
Medical Practice Act. In addition to establishing qualifications
for licensure, the Board is responsible for investigating
complaints against licensees and for taking action against the
license of those who fail to maintain Maryland's high standards
of medical care delivery or who break the laws governing
licensure. You can download a complaint form (PDF) from this
website.
|
| Massachusetts
|
|
Commonwealth
of Massachusetts Board of Registration in Medicine
Complaints Brochure (PDF)
The mission of the Board is to serve the public by striving to
ensure that only qualified physicians are licensed to practice in
the Commonwealth, to ensure that those physicians and health care
institutions in which they practice provide to their patients a
high standard of care, and to support an environment that
maximizes the high quality of health care in Massachusetts. The
Board investigates complaints, holds hearings and determines
sanctions. These functions are critical to protecting the public
by ensuring that only competent physicians and acupuncturists are
practicing in Massachusetts. The Board offers this
patient’s guide to complaints.Commonwealth
of Massachusetts Office of Consumer Affairs and Business
Regulation
Consumer Service responds to inquiries and intervenes on behalf
of consumers to resolve complaints against insurers, agents, and
other licensees. Consumer Service provides consumers with general
insurance information and advises them, when appropriate, of
their rights under their insurance policy and the applicable
Massachusetts insurance laws. Protection of consumer interests is
of prime importance to the Division and is safeguarded by
providing accurate and unbiased information so consumers may make
informed decisions and by intervening on behalf of consumers who
believe they have been victimized by unfair business practices.
This website explains how to file a complaint and gives you the
opportunity to download an insurance complaint form.
Office of Patient Protection
This site describes the Office of Patient Protection, which
assists you in understanding your rights with your health
carrier. The Office of Patient Protection can also help you with
internal grievances, appeals of benefit denials, medical
necessity guidelines, continuity of care, and independent
external reviews. Contact the Office of Patient Protection at
1-800-436-7757.
|
| Michigan |
|
Michigan Department of Labor and Economic
Growth
This website will instruct you on how to file a complaint,
grievance or external appeal and informs you about each process.
Forms to download are provided.
|
| Minnesota
|
|
Minnesota Department of
Commerce
1-800-657-3602
The Department of Commerce handles complaints about the
businesses they regulate and oversee which include insurance
companies.
Office of Health Facility
Complaints
Consumers of health care services have a
responsibility to promote the highest quality of care. If you
witness a suspected violation of health department regulations,
patient and residents' rights or the MN Vulnerable Adults
Protection Act (physical or mental abuse, neglect, or unexplained
injury) call the Office of Health Facility Complaints
(OHFC). Quality Assurance and Performance
Measurement
Quality Assurance of health plans is
monitored through auditing and examination procedures at the
health plan level and investigating individual enrollee Quality
of Care complaints. If you have a complaint about how your health
plan is operating, this is the office you want to
contact.
Minnesota
Board of Medical Practice
This website provided Step by Step instructions on how to file a
complaint along with an overview of the complaint process and
corrective actions options.
|
| Mississippi
|
|
MississippiState
Board of Medical Licensure
Website explains how to file a complaint with the Board.
Mississippi Department of Insurance Consumer
Services Division
(800) 562-2957
This website gives you information on how to file a complaint
with the Department of Insurance. The site provides a complaint
form that can be downloaded or submitted online.
|
| Missouri
|
|
Missouri Department of Insurance
Complaints
1-800-726-7390
-Don't understand your insurance policy? Do you think you have
been treated unfairly by your insurance company, agent, broker or
agency? The MDI welcomes any questions or complaints you may
have. In 2001, consumer service specialists provided information
to 67,317 persons and investigated 6,122 formal complaints
against insurance companies and administrators. This website
provides a complaint form that can be downloaded. This site also
gives you the opportunity to submit your complaint online.
Missouri Department of Health and Senior Services
Ombudsman Program
Missouri's ombudsman program
consists of ombudsman/volunteers serving residents of nursing
homes and residential care facilities to provide support and
assistance with any problems or complaints.
|
| Montana
|
|
Montana Commissioner of Insurance &
Securities
Montana Department of Consumer
Protection
(406) 444-4500
In Montana the Department of Consumer Protection within the
Department of Administration is responsible for most aspects of
consumer affairs. Within this site can be found a consumer
protection complaint form.
|
| Nebraska
|
|
Nebraska
Department of Insurance
402-471-2201
Based on the complaint information you wish to send to the
Department, you may file your complaint electronically or by
mail. If you do not wish to print a complaint form using the
Adobe Acrobat Reader or you do not wish to submit your complaint
electronically, you can contact the Department at 402-471-2201
and a complaint form will be sent to you for completion. This
website gives instructions on how to submit a complaint.
NebraskaHealth and
Human Services System Professions and Occupations Investigations
Unit
This Unit is responsible for investigation of licensed,
registered or certified health care professionals and
professionals in healthcare-related fields and unlicensed
healthcare practice. This website gives an overview of the
complaint process and provides a complaint form for downloading.
Office of Dispute Resolution
402-471-3148
The 1991 Dispute Resolution Act established the Office of Dispute
Resolution (ODR) in the Administrative Office of the Courts.
ODR, with input from the ODR Advisory Council, oversees the
development of dispute resolution and collaborative problem
solving programs in Nebraska, assisting in the development of,
and working collaboratively with, Nebraska's nonprofit mediation
centers. The public-private cooperative effort creates an
efficient, effective and responsive system that enhances existing
structures and fosters new opportunities to prevent and resolve
conflict.
NebraskaOffice of
the Attorney General
You may file a complaint in one of two ways: 1) Call the Consumer
Protection Division of this office at 1-800-727-6432 and request
that a complaint form be sent to you. Fill out the form, and
return it to their office. 2) Access a complaint form online from
this website by clicking the Online Forms link, Nebraska Attorney
General Online Forms and send the complaint electronically. Once
they receive your completed complaint form, they will review it
to make sure your complaint falls within our jurisdiction. If
your complaint is under the jurisdiction of another state or
federal agency, they will forward it to that agency for you. If
you have questions about these processes call (402) 471-2682, or
en Espanol at (402) 471-3891.
|
| Nevada
|
|
Nevada Department of Insurance
A complaint can be submitted by any person who has an
insurance-related problem. Attempts should first be made to
resolve the problem with the insurance company as most insurance
companies have personnel specifically for dealing with
complaints. This website explains the complaint process. You may
download a complaint form from this site or you may submit the
complaint form online.
State of Nevada Board
of Medical Examiners Complaint Investigation
Division
775/688-2559 (in Reno) or 888/890-8210 (elsewhere in Nevada)
This website provides a complaint form that can be printed.
|
| New
Hampshire
|
|
New Hampshire Insurance Department Complaint Form
(PDF)
The Consumer Division of the New Hampshire Insurance Department
attempts to mediate disputes between consumers and their
insurance companies or agents. The Department cannot act as your
lawyer, give legal advice, recommend or rate insurers. You may
download the complaint form from this site and mail it to the
address given on the form. Once received, your complaint will be
acknowledged in writing and your complaint will then be forwarded
to the company or agent for their response. You will be contacted
again once a response is received. If the Insurance Department is
unable to obtain the resolution that you seek, you may wish to
contact an attorney for advice or other remedies available to
you. New HampshireState
Board of Medicine
The mission statement of the Board is to protect the public from
the unprofessional, incompetent, or impaired practice of
medicine. The Board of Medicine issues licenses to qualified
Allopathic and Osteopathic physicians and physician assistants
based on nationally recognized credentialling standards. The
Board regulates the minimum standards for professional conduct
and continued competence and takes disciplinary action against
licensees who fail to meet these standards. A consumer complaint
may be downloaded from this website. A Consumer Guide to Handling Disputes with your
Employer or Private Health Plan
This site provides brief information on how to handle disputes
with your private health plan.Managed Health Care Guide to External Review
(PDF)
New Hampshire Law gives you the right to an External Appeal when
health care services are denied by your managed care insurer on
the basis that the services are not medically necessary or are
experimental or investigational. This guide explains the External
Appeal process and how to submit an Appeal.
Request for Independent External
Appeal of Health Care Decision (PDF)
|
| New
Jersey |
Community Health Law Project
To Your Health: Your
Consumer
Rights in Managed Health
Care
This 74-page consumer guide to managed health care is available
free-of-charge as part of the Law Project’s “To Your
Health” program. Simply call the toll-free Managed Care
Helpline at 888-838-3180 and ask them to send you a
copy. New Jersey Office of Managed Care: How to File a
Complaint
Under New Jersey law, every person covered under a managed care
plan has the right to file a complaint with his carrier about any
aspect of the coverage under the managed care plan, the carrier's
network, and the services provided by health care providers in
the carrier's network --This site explains how.Consumer Complaints
Questions and issues from individuals regarding financial and
contractual complaints including medical and dental claim
disputes. Downloadable complaint form in
Adobe Acrobat format.
Department of
Banking and Insurance
The Department of Banking and Insurance's Consumer Protection
Division will investigate medical insurance claims disputes
reported by New Jersey medical insurance consumers.
|
| New
Mexico |
|
New Mexico
Public Regulation Commission External Review
Process
1-877-673-1732
An external review is a review of your case after a denial has
been issued by your managed health care plan and you have
completed the plan’s internal review process. You may
submit a request for an external hearing from the Insurance
Division. If after staff reviews your request and the hearing is
granted, it will be heard by members of an independent panel.
These panel members will have no relation to your managed health
care plan, the consumer, or the Insurance Division. This website
explains the different types of reviews and their processes.
New Mexico
Public Regulation Commission Managed Health Care
Complaint Form (PDF)
New
MexicoMedical
Board
505-827-8491
The New Mexico Medical Board is responsible for protecting the
health and safety of the public. As part of that responsibility
the Board evaluates complaints against medical doctors (MDs) and
physician assistants (PAs) that allege unprofessional conduct,
unethical conduct, or other violations of the Medical Practice
Act. When the Board receives a written complaint it goes directly
to the investigative staff. The Board investigates all complaints
over which it has jurisdiction, or the authority to act.
There is a complaint form that you can download
from this website.
|
| New
York |
|
What to do if you've chosen the Wrong
Physician
Advice on selecting doctors and filing
complaints from NYS Department of Health.New York City Managed Care Consumer Assistance
Program (MCCAP)
From site: "The MCCAP is a resource for
general information about managed care, for specific information
to help you understand your managed care or health plan, and for
counseling and advice when you need help getting specific
services."NYS Department of Health, Office
of Professional Conduct Information
(518) 474-8357
The Office of Professional Medical Conduct
(OPMC) is responsible for investigating complaints about
physicians, physician assistants and specialist assistants. The
Office also monitors practitioners who have been placed on
probation.
New York External
Appeals
Office of New York State
Attorney General
(800) 771-7755 or (518) 402-2163
Advocates on behalf of consumers and
providers who are experiencing difficulty in dealing with managed
care organizations.The New York State Department of
Insurance
1-800-342-3736
The New York State Insurance Department licenses insurance
companies, brokers, agents, and adjusters to operate in this
State. If you believe that one of these licensees has failed to
act in accordance with your contract or New York Insurance Law
and Regulation, the Department of Insurance asks that you to file
a complaint. This website provides you with the two methods of
filing a complaint, on-line or by hard copy. This site also
provides external appeal information and applications.
|
| North
Carolina |
|
Department of Insurance,
Consumer ServicesNorth CarolinaMedical
Board
919-326-1100
When you do face a problem with a physician, physician assistant,
nurse practitioner, or clinical pharmacist practitioner you want
to know who you can tell. When you believe that a medical
professional's performance or behavior is not what it should be,
you want someone to listen to you and to look into the situation.
That is one of the most important tasks of the North Carolina
Medical Board. The North Carolina Medical Board exists to protect
the public interest. It does this by enforcing the North Carolina
Medical Practice Act, licensing (or approving) and overseeing the
practice of physicians, physician assistants, nurse
practitioners, and clinical pharmacist practitioners. (The Board
deals with individual practitioners, not institutions or
organizations such as hospitals or managed care organizations.)
This website explains the complaint process. You are also given
the opportunity to submit your complaint online or download a
complaint form from this site.
|
| North
Dakota |
|
North Dakota Department of
Insurance
800-247-0560
The primary mission of the North Dakota Insurance Department is
to help and protect consumers. Many times, the problems relating
to health insurance come down to a miscommunication,
misunderstanding of filing procedures, or confusion over the
definition of terms. At these times, a simple call from an
insurance department employee can quickly resolve a dispute. Even
in situations in which the department has no powers of
intervention, the staff is often able to point the consumer in
the right direction and headed on the road to resolution. This
website explains how to file a complaint through the Department
of Insurance and the complaint process. The site gives you the
opportunity to download a complaint form or file the complaint
online.North
DakotaState Board of
Medical Examiners
701-328-6500
A citizen may file a complaint against a physician or a physician
assistant by submitting a written statement to the North Dakota
Board of Medical Examiners. If you wish to file a complaint you
may print the complaint form found on this website. If you have
any questions about completing the form you may call for
assistance at 701-328-6500. It is most important that you state
your concerns as clearly as possible and that you are very
specific in describing your allegations.
|
| Ohio |
|
How to File a Complaint
with the Insurance Department Insurance Company Complaint
Comparision
A chart detailing all insurance companies
in OH with their rate of complaintsHMO
Disputes
Directions on how to resolve HMO Disputes
in OhioAppeals: When You
Disagree with the Insurance Company in Ohio
The steps to take when you disagree with
the insurance company in OhioHMO
Appeals
HMO Appeals Process in
OhioState Medical Board of Ohio
For complaints about a physician, osteopathic physician,
podiatric physician, physician assistant, anesthesiologist
assistant, massage therapist, cosmetic therapist, acupuncturist,
mechanotherapist or naprapath. This website provides a complaint
form that can be submitted online or may be downloaded and
completed offline and mailed.
|
|
Oklahoma
|
|
Oklahoma Insurance Department
The Oklahoma Insurance Department Consumer Assistance/Claims
Division processes and investigates all complaints Lodged against
insurance companies by the public. This division also answers
routine requests for information concerning insurance companies
and policies. This website explains the complaint process and
provides a consumer complaint form that can be downloaded. This
site also answers some FAQ.Medicare Advantage Immediate
Appeals
This educational program explains the Medicare Immediate Appeal
Process for Medicare Advantage enrollees receiving services from
Home Health Agencies, Skilled Nursing Facilities, and
Comprehensive Outpatient Rehabilitation
Facilities.OklahomaFoundation
for Medical Equality Medicare Beneficiary
Hotline
1-800-522-3414
Medicare beneficiaries can file a complaint if they feel the
care received in the following facilities was of poor quality or
did not meet expectations: • Hospital • Home Health
Agency • Skilled Nursing Facility • Outpatient
Department • Emergency Room • Hospice. The Oklahoma
Foundation for Medical Equality (OFMQ) 501 (c) (3) is a
not-for-profit, charitable and educational organization founded
in Oklahoma in 1972 to advance cost-effective, quality health
care through evaluation, education and
research.Oklahoma
Board for Medical Licensure & Supervision
(OSBMLS)
405-848-6841
Doctors (MD), Physician’s Assistants (PA), Physical
Therapists (PT), Physical Therapy Assistants (TA), Occupational
Therapists (OT), OccupationYou have the right to file a complaint
with this agency. The OSBMLS has jurisdiction over the following
professionals: Medical al Therapy Assistants (OA), Athletic
Trainers (AT), Registered Electrologists (RE), Respiratory Care
Practitioners (RC), Licensed Dietitians (LD), Pedorthists (LPED)
and Orthotists/Prosthetists (LO/LPR). They also contract their
investigative services for Podiatrists (DPM) and Perfusionists
(LP). This website provides a complaint form and explains the
complaint process.
|
| Oregon
|
|
Oregon Department of Consumer and Business
Services Insurance Division
503- 947-7980
The Insurance Division's Consumer Protection Section resolves
thousands of consumer complaints each year. Most complaints
involve disputes with insurance companies about claims processing
and benefits. Examples of other complaints include problems with
the sales and servicing of insurance policies. You have the right
to file a formal complaint against an insurance company or
insurance agent at any time. To file a complaint, complete the
interactive complaint form or download a copy of the PDF
complaint form.
OregonBoard of Medical
Examiners
877- 254-6263
The mission of the Oregon Board of Medical Examiners is to
protect the health, safety, and well being of Oregon citizens by
regulating the practice of medicine in a manner that promotes
quality care. Each year the Board of Medical Examiners receives
over 1,000 complaints. Approximately 300-400 of those complaints
result in a complete and detailed investigation. Some complaints
are referred to other appropriate state or professional
organizations for review. Others are resolved quickly by the
Board's investigative staff because initial investigation found
that the licensee did not violate any state law or regulation.
The complaints come from a variety of sources, including other
health professionals, hospitals, and patients and their families.
This website explains how to file a complaint.
|
| Pennsylvania |
|
Pennsylvania External
Appeals Pennsylvania Insurance
Complaint Form
As an insurance consumer of the Commonwealth of Pennsylvania, you
may submit a complaint electronically via this site. If your
complaint requires submission of supporting documentation, we
urge you to submit your package of correspondence and the
complaint form by mail or fax.
What to do if your health
insurance claim is denied in Pennsylvania
If your health insurance claim is denied, you first should review
your health insurance policy or employee benefits booklet to
determine the appeal rights provided to you under the policy. If
you remain dissatisfied after exhausting the appeal mechanism
provided by your policy, contact the Pennsylvania Insurance
Department to request assistance in determining other remedies or
rights you may have. Contact information and a link to the PA
state complaint form are linked from this page.
Pennsylvania
State Board of Medicine
800-822-2113The State Board of Medicine regulates the practice of
medicine through the licensure, registration and certification of
members of the medical profession in the Commonwealth of
Pennsylvania. The Board regulates medical doctors; physician
assistants; radiology technicians; respiratory care
practitioners; nurse-midwives; and acupuncturists. The Board
also has authority to take disciplinary or corrective action
against individuals it regulates. This website explains how to
file a complaint and the complaint process. The site also has a
complaint form to download.
|
| Rhode
Island
|
|
State of Rhode Island Department of the Attorney General
Consumer Protection Unit
The Consumer Protection Unit investigates and mediates consumer
complaints concerning unfair and unlawful business practices and
misleading advertising arising out of alleged violations of the
Deceptive Trade Practices Act. You may download a complaint form
from this website.Rhode IslandBoard of
Medical Licensure and Discipline
401-222-5200
The Department of Health and/or the Boards are granted the
authority to investigate and adjudicate complaints of
"unprofessional conduct" on the part of any person licensed by
the Department of Health. Unprofessional conduct includes, but is
not limited to issues related to standards of care of a given
health profession, as well as issues regarding abuse/neglect, any
willful misconduct in the practice of health care and/or any
criminal misconduct on the part of the Health Care Professional.
This website explains the complaint review procedure and how to
file a complaint. You may also download a complaint form from
this site.
Where and How to File a Complaint (Long Term
Care)
This website suggests where you can go to complain if you have
issues with your long term care provider.
|
| South
Carolina
|
South Carolina Department of
Insurance Consumer Services
Official site of the South Carolina
Department of Insurance Consumer Services. Site visitors can
access a variety of insurance-related information, including
information about health insurance in South Carolina. Click on
the “Health” link under the “Consumer
Categories” section to learn more about health insurance in
South Carolina. Other useful services such as consumer complaint
resources and fraud alerts can also be found within this
site.
South CarolinaBoard
of Medical Examiners
(803) 896-4500
The Board is responsible for disciplining physicians, physician
assistants, respiratory care practitioners and acupuncturists
found in violation of the Medical Practice Act. This encompasses
illegal, unethical or incompetent conduct. All initial complaints
are investigated by full-time investigators who are employed for
this specific purpose. After the investigation is complete, the
Board's legal counsel recommends whether a formal complaint is
warranted. If the investigation reveals that the initial
complaint is without substance, counsel will recommend that the
complainant and the licensee be notified of the dismissal.
Complaints that are dismissed are not public records. This
website explains the complaint process and will also advise you
how you can obtain a complaint form.
|
| South
Dakota
|
|
South Dakota Division of
Insurance
605-773-3563
If you are having an insurance related problem, the division may
be able to offer assistance. While they cannot ultimately force
an insurance company to pay, the division's role is to ensure
that an insurer (or agent) is honoring the policy of insurance,
and following state law in the sale and administration of
policies. If you feel that an insurance company or agent is not
acting in accordance with the policy, or with state law, and does
not seem willing to resolve the matter, they encourage that you
remit a complaint to the division.South Dakota Department of Health, Health Care Facility
Complaints
1-800-738-2301
Site explains how to file a complaint about poor quality, abuse,
or neglect by a health care facility.
South DakotaBoard
of Medical and Osteopathic Examiners
605-336-1965
The mission of the South Dakota Board of Medical and Osteopathic
Examiners is to protect the health and welfare of the state's
citizens by assuring that only qualified doctors of medicine,
doctors of osteopathy, physical therapists, advanced life support
personnel, physician assistants, athletic trainers, occupational
therapists, respiratory therapists, nurse practitioners, nurse
midwives, and dietitians are licensed to practice in South
Dakota. The Board of Medical and Osteopathic Examiners requires
that all complaints be in writing. Also, the Board does not
investigate anonymous complaints.
|
| Tennessee |
Tennessee Department of Health, Division of Health
Related Boards
1-800-852-2187
When a problem is experienced with a practitioner, you have the
right to report him/her. If you believe that a
practitioner’s performance or behavior is not acceptable,
you may file a complaint through Health Related Boards, Office of
Investigations. This website explains the complaint process and a
complaint form can be downloaded from this
site.Tennessee Department of Health, Health Care
Facilities
1-877-287-0010
When a problem is experienced with a specific licensed and/or
certified facility, you should file your complaint with the
Division of Health Care Facilities. This website explains the
complaint process and a complaint form can be downloaded from
this site.Tennessee Department of Health Division of Emergency
Medical Services EMS
Investigations
(615) 741-2584
Many complaints arise from misunderstandings. You may be able to
resolve complaints by direct communication with the service
director. If you are not satisfied with the response, you may
file a complaint with the Division of Emergency Medical Services
(EMS).Tennessee Department of Commerce Consumer Insurance
Services
1-800-342-4029
This section coordinates several consumer oriented programs such
including interceding in insurance claims and other insurance
related disputes.Tennessee Department of Commerce
Consumer Insurance Services Complaint Form (PDF)
A
Consumer Guide to Handling Disputes with your Employer or Health
Care Plan
This website information is provided by the Kaiser Family
Foundation. For HMOs, Tennessee requires consumers to use their
health plan’s internal grievance process prior to asking
the Commissioner of the Insurance Division for a review. Health
plans must provide not only an initial review, but also a
reconsideration of the review if you request one. If you are
unsatisfied with the results of your review you may either ask
your health plan for an independent review, which can cost $50,
or can ask the Insurance Division to review the decision, which
is available at no charge. The two processes use different rules
and timelines; independent review through the health plan is
described on this website. HMO grievances filed with the
Insurance Division are reviewed by Division staff, which includes
a physician.
|
| Texas
|
|
Texas Department of Insurance Complaint
Form
(800) 252-3439
This website explains the complaint process and gives you the
opportunity to either download a complaint form regarding an
insurance company, or submit one online.Texas Department of Insurance Physician/Provider
Complaint Form
This website explains the complaint process and gives you the
opportunity to either download a complaint form regarding a
physician/provider, or submit one online.Texas State
Board of Medical Examiners
1-800-201-9353
If you wish to complain to the Board, they ask that you do so in
writing. Provide full name and practice address of practitioner.
Also, provide dates and details of any incident, being as
specific as possible. The Board will acknowledge receipt of your
complaint. If your complaint is within the Board's jurisdiction,
it will be assigned for proper study. Complainants are advised of
an investigation status approximately every 90 days until final
action is taken.
Where to File a Complaint in
Texas
This Department of Insurance website directs you to where you can
file your complaints.
|
| Utah
|
Utah Insurance Department Contact
Information
Scroll down to find names and contact
information for the "Office of Consumer Health Assistance." The
consumer service representative's phone number is (801)
537-9294.Utah Department of
Insurance
1-800-439-3805
Their consumer service personnel are available to help Utah
consumers get answers to their insurance questions and to solve
some insurance problems. This website explains how to file a
complaint and gives you the opportunity to do so online.
UtahDivision
of Occupational and Professional Licensing
(DOPL)
Every day the Utah Division of Occupational and Professional
Licensing (DOPL) receive complaints regarding the conduct of
individuals practicing in regulated occupations and professions.
Complaints are received from many sources including the general
public, co-workers, licensing board members, professional
associations, other state agencies, and federal disciplinary
databases. DOPL is legislatively responsible to investigate acts
or practices inconsistent with generally recognized standards of
conduct, unlicensed practice in regulated professions or
occupations, allegations of gross negligence or incompetence, and
patterns of negligence or incompetence. This website provides the
opportunity to file a complaint online.
|
| Vermont |
|
Health Care Insurance Consumer Assistance
(800) 631-7788, (802) 828-2900
This state program assists consumers with questions and concerns
related to the quality of health care services received through
Health Maintenance Organizations (HMOs), managed care plans, and
other health insurance plans licensed by the state.
Consumer Help and
information Insurance Division
This site lists health insurance companies
that are licensed in Vermont, consumer information and state
regulations. DHCA offers assistance and investigates consumer
complaints related to health insurance and managed care plans.
Consumer services specialists are available at 1-800-631-7788 to
answer questions and provide educational materials about health
insurance. DHCA also administers the state's external appeals
program.Vermont Protection and
Advocacy
800-834-7890
This site describes Vermont Protection and Advocacy
investigations which include complaints of abuse and complaints
of violations of individual rights (the right to refuse
treatment, right to privacy, access to medical records,
confidentiality).
Vermont Protection & Advocacy is separate and independent
from all state agencies, hospitals, and community mental health
centers. VP & A helps the mentally ill.
Vermont
Board of Medical Practice
One of the duties of the Vermont Board of Medical Practice is to
investigate complaints of unprofessional conduct by licensees and
to take action where appropriate to protect the public health and
safety. This website explains the complaint process and a
complaint form can be downloaded from this site.
|
Virginia
|
Independent External
Appeals in Virginia
This page, from the Virginia Bureau of
Insurance, provides the procedure for filing an independent
external appeal including: Do you qualify for an External
Appeal?, How does an External Appeal work?, and the External
Appeal Form.Virginia Bureau of
Insurance Consumer Assistance
In an average year, in addition to providing many forms of
assistance that have nothing to do with money, the Virginia
Bureau of Insurance is responsible for having more than $10
million returned to Virginia consumers in the form of refunds,
benefit payments, changed claim determinations, and the like.
Virginia
Department of Health Professionals
1-800-533-1560
The Department of Health Professions receives complaints about
health care practitioners who may have violated a regulation or
law. Complaints for all the licensing and regulatory Boards are
received and processed by the Enforcement Division. Complaints
may be submitted to the Enforcement Division in writing, by
telephone, fax, email, in person, or anonymously.
|
| Washington
|
|
2002 Health Care
Insurance Company Complaint Report
A tally of complaints against health plans
in Washington along with their ratio of complaints per $1 million
in premiums collected for 2002.Insurance Complaint
Investigations
The Office of the Insurance Commissioner
will investigate the complaint of any insurance consumer who
feels he or she was treated unfairly by a carrier. To file a
complaint, fill out one of the complaint forms listed on this web
page or call their toll free number. Washington State Department of Health, Health
Professions Quality Assurance
Secretary of the Department of Health and 16 boards and
commissions (boards) are authorized by the legislature to
discipline health care providers who violate the law.
Before making your decision to report a health care provider,
keep in mind that many common complaints such as scheduling
problems, personality conflicts, or disputes
over bills or insurance are usually not within the Department or
board’s legal authority to take action. Reports involving
fees or insurance claims are only investigated if there appears
to be fraud involved. This website helps explain what a complaint
is and how the complaint process works. This site also answers
some FAQ.
Washington State Department of
Health, Health Professions Complaint Form (PDF)
|
| West
Virginia |
|
|
| Wisconsin |
|
The State of Wisconsin,
Department of Regulation and Licensing
The State of Wisconsin, Department of Regulation and Licensing is
the state agency responsible for credentialing and regulating
various professions in the State of Wisconsin. Department staff
may investigate complaints against persons credentialed by the
department and boards, and may pursue disciplinary action against
those individuals if there is evidence of a violation of the law.
Any complaint falling within the jurisdiction of another agency
will be referred to that agency for further action. A complaint
form can be found on this website.
The Office of
the Commissioner of Insurance
1-800-236-8517
The Office of the Commissioner of Insurance assists complainants
with their insurance problems. A complaint form can be downloaded
from this website.
|
|
Wyoming
|
|
Consumer Health Insurance
Complaints
If you are an insurance consumer in Wyoming and are having
problems with your insurance company that you have not been able
to resolve, you may contact this department for assistance.
Please download the following consumer complaint form and mail it
to the Wyoming Department of Insurance at the address given on
the form. They will look into the situation for you.
The State of Wyoming
Board of Medicine
1-800-438-5784
If a patient has a complaint, they may call the Board, toll-free
to discuss the matter. However, prior to opening a docket and
initiating an investigation, Board rules require a written
complaint naming the physician and/or PA involved, the patient
and a detailed narrative describing what happened and when. The
complaint must be signed and include the complainant’s
address and telephone number. The Board will not consider
anonymous complaints or a complaint received via e-mail. The
Board does not usually involve itself in fee disputes.
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