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.
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.
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. You can also use this form for other health insurance disputes such as if your health insurer cancels your policy.
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
looking for online forms instead of the printable ones listed on this page?
200 St. Paul Place, Baltimore, MD 21202
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