Property of NORD, Inc.
Rarediseases.org
You can find your State Commissioner Insurance Commission's address by going to
http://www.naic.org/state_web_map.htm .
Sample Complaint Letter to State Insurance Commission:
Name of State Insurance Commission
Name of Your Insurance Company
Address of Insurance Company and Telephone Number
Dear Insurance Commissioner:
I have filed the attached insurance claim with _______________(insert name of your
insurance company) on___________(insert date[s]).
My physician has deemed this therapy/procedure/drug/etc. medically necessary for my
medical condition. However, 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 has been denied, etc.)
Please accept this letter as a formal written complaint against_______________(insert
name of your insurance company).
Sincerely,
Your Name
Your Address and telephone Number
CC: Medical Director, _________________(insert name of your insurance company).
CC: Your physician
