Important: If your complaint does not involve a health insurance claim, we cannot help you get payment for services you provided.
When filing a complaint about health insurance:
- If you include the patient's name or personal information, you must include the patient's signed medical release. This is on page 3 of the printable complaint form (PDF, 124KB).
- If you're only submitting general claim information that does not include patient names or personal information, you don't need a medical release.