Privacy Note: The information you submit and that we obtain will be used by the Attorney General staff in investigating your complaint. Medical or psychological information about an individual will not be disclosed to the public. To read our full privacy policy, click here.
Use this form if your health plan has refused to pay for a service, is refusing to pay for future treatment, has paid less than you think they should have paid for your treatment/service, or has canceled your policy.
Formulario de reclamo de seguro médico denegado en español
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. You can also use this form if you have unresolved problems with enrolling in or renewing coverage in a Qualified Health Plan through Maryland Health Connection, or if you have an issue with your 1095-A tax form.
**If you are enrolled in a plan through Maryland Health Connection and want to appeal your health insurer's decision to cancel your policy due to non-payment, please complete the “Health Insurance Appeal" complaint form above.
Formulario de Apelacion de la decision de Maryland Health Connection en español
Use this form if you have a billing dispute with your hospital, doctor, dentist, or other healthcare provider. You can also use this form if you have problems with medical equipment that is defective or was never delivered, have trouble obtaining your medical records from a healthcare provider, have been overcharged by a healthcare provider for your medical records, or need help navigating a hospital's financial assistance program.
**If your complaint is only about the quality of care you, a family member, or a friend experienced, the HEAU will be unable to assist you. You can click HERE for a list of Maryland state agencies that you should file your complaint with.
Formulario de disputa de facturación o equipo médico en español
Use this form if you are a healthcare provider filing a complaint on behalf of your patient.
If your complaint is not about healthcare issues, please click here to be redirected to the Consumer Protection Division's Mediation Unit.
Documents: 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.
Authorization form needed: In most cases we will need copies of relevant records from your healthcare provider and/or insurance carrier. You will need to submit an authorization form so we can obtain your medical, insurance, and billing records. This authorization also allows us to release or redisclose your records and other information related to your complaint to your healthcare providers and/or insurance carrier and to other state or federal government agencies that may assist in the resolution of the complaint.
If you need our assistance with your Maryland Health Connection appeal, you will need to complete an Authorized Representative Form. For denials of premium tax credits or cost-sharing reductions, consumers need to provide copies of financial records that show proof of household income.
Problems: If you are unable to download or print a complaint form, please call or email our office to have one mailed to you. We can be reached at:
Phone: 410-528-1840 or toll-free in Maryland at 1-877-261-8807
En español 410-230-1712
Email: HEAU@oag.state.md.us
1-888-373-7888
233733
