Education and Advocacy Unit
Instructions to File a Complaint by Mail
1. Gather any documents that are relevant to your complaint. Examples
• 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.)
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.
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.
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.