Sample Complaint Letter to State Insurance Commission

Name of State Insurance Commission

Street Address

City, State, Zip Code

Dear Insurance Commissioner:

I have filed the attached insurance claim with _____________(insert name of your insurance company) on _____________ (insert date of claim). My physician has deemed this therapy medically necessary for my medical condition, but my insurance company has denied me access to the standard of care. I have had the following specific problems with this insurance company:

(List all of your problems such as refusal to cover physician prescribed therapy, claim has not been paid or denied, etc.)

Please accept this letter as a formal written complaint against _____________(insert name of your insurance company).


Your Name

Your Address, City, State, Zip Code, and Telephone Number

cc: Medical Director, _______________ (insert name of your insurance company).

Your Physician

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