Please note: Gather any documents that are relevant to your complaint prior to filling out a complaint form. Please do not send us any original documents; send us copies only.
If you are unable to download or print a complaint form, please call our office to have one mailed to you:
410-528-1840 or toll-free in Maryland:
Use this form if you have a billing dispute with your hospital, doctor, dentist, or other healthcare provider. You can use this form if you are seeking a refund for medical equipment that is defective or was never delivered, or if you have other medical equipment problems.
Formulario de disputa de facturación o equipo médico en español
Use this form if your health plan has refused to pay for a service, is refusing to pay for future treatment, or has paid less than you think they should have paid for your treatment/service. You can also use this form for other health insurance disputes such as if your health insurer cancels your policy.
Reclamo de seguro médico denegado
Use this form if you would like our assistance in filing an appeal of a Maryland Health Connection decision denying Qualified Health Plan coverage or denying Advanced Premium Tax Credits or Cost-Sharing Reductions. Use this form if you have unresolved problems with enrolling in or renewing coverage in a Qualified Health Plan through Maryland Health Connection.
Formulario de Apelacion de la decision de Maryland Health Connection en español
Use this form if you are a healthcare provider filing a complaint on behalf of your patient.
Use this form if your complaint is not about medical healthcare issues.
200 St. Paul Place, Baltimore, MD 21202
410-576-6300 / En español 410-230-1712 / 1-888-743-0023 toll-free / TTY: Dial 7-1-1 or 800-735-2258