Instructions to File a Complaint by Mail
1. Gather any documents that are relevant to your complaint. Examples include:
billing statements from your doctor or other provider;
an adverse coverage decision from your carrier; and,
(You may need to refer to these documents while you are filling out the complaint form and will need to send copies of these documents to our office after you file your complaint.)
2. Download the complaint form.
(If you are unable to download or print the complaint form, call our office to have one mailed to you: 410-528-1840 or toll-free in Maryland: 1-877-261-8807.)
3. Fill out the form on the computer, then print it; or print it out to complete by hand.
4. Sign and date the Authorization for the Release of Medical Information to the Health Advocacy Unit.
(This form is necessary so that we can obtain medical information related to your complaint and communicate with the necessary people in our effort to resolve it.)
5. Mail to our office:
The filled out complaint form;
A completed Authorization for the Release of Medical Information to the Health Advocacy Unit;
Copies of any documents that are relevant to your complaint. (NOTE: Please do not send original documents.)
6. Keep a copy of the complaint for your records.
Receipt of the Complaint Form, the completed Authorization for the Release of Medical Information to the Health Advocacy Unit, and copies of other documents relevant to your complaint are necessary to begin the mediation process.
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