Health Education and Advocacy Unit

ONLINE FORM INSTRUCTIONS - MEDICAL BILLING OR EQUIPMENT DISPUTE

1. Print and Complete the Authorization for Release of Medical Information
   
               We need this release form in order to proceed on your behalf.
   
2. Fill out the Complaint Form HERE.  When your information is complete; click the "Submit" button.
   
3. You will receive a "Complaint Confirmation" page.  Please print out two (2) copies of the "Complaint Confirmation" page - one for your records and one to send to us.
   
   The "Complaint Confirmation" contains the information you provided along with other important information about how we will handle your complaint.
   
4. Send the following documents to our office via mail, email or fax:

• The "Complaint Confirmation"  page
  
• A signed and dated Authorization for the Release of Medical Information
  
• Copies of any documents relevant to your complaint. (NOTE: Please do not send original documents.)
  
  

Office of the Attorney General, Health Education and Advocacy Unit
200 St. Paul Place, 16th Floor
Baltimore, MD 21202

(410) 528-1840
FAX (410) 576-6571
Toll-free in Maryland
1-877-261-8807
Email: heau@oag.state.md.us

Receipt of the "Complaint Confirmation," the Authorization for Release of Medical Information and copies of other documents relevant to your complaint are necessary to begin the mediation process.