Sample Complaint Letter

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Sample Complaint Letter Access to Mental Health Providers Dear Ohio Department of Insurance: RE: Name ______________________ Insured’s Name ________________________________ Insurance Company ____________________________ Policy/ID Number (if SS# - only give last four digits) ______________________________ Group or Employer Name __________________________________________________ I am writing to file a complaint about the lack of providers of mental health treatment in my insurance plan, ___________________________________________[insert name of insurance company]. 1. In attempting to find a provider in my insurance company’s network, I ___________________________________________________________________________________ _________________________________________________[insert # of providers called, outcome of calls, etc.]. 2. When I was finally able to find a provider who would accept my insurance, I was told that I could not have an appointment until __________________________________________________________________[insert month and year, how long from current date]. 3. I needed an appointment right away because ___________________________________________________________________________________ _________________________________________________[insert reason for seeking care]. I do not understand why I can not find an in-network provider. Without adequate network provider panels, my insurance plan does not include needed specialists, does not provide readily accessible providers, and does not provide well-qualified and appropriate providers. If I can not reasonably find a qualified mental health care provider in my insurance plan, then it does not seem that my insurance plan is meeting the requirements of Ohio law, specifically RC 1751.13 (A)(2). I am asking that my insurance company provide healthcare service from a noncontracted provider, at no greater cost than I would pay if I had obtained the service from a contracted provider. I would appreciate a written response to my complaint. Sincerely, (insert your printed name here) (Address) (City, State, Zip) (Daytime Telephone #) Cc: Insurance Company Elected State Representative Elected State Senator

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