Complaint Information Checklist

For our staff to begin evaluating and analyzing your request, specific information is necessary. Review the following checklist to ensure you are providing the necessary information. Be sure to include a detailed summary of the problem and attach copies of documents supporting your claim. Failure to provide this information may delay or limit our ability to help you.

  • A detailed summary of the problem
  • Your name
  • Complete address
  • Day-time telephone number
  • Cell phone number if available
  • Email address if available
  • Insurance company issuing the policy
  • Type of insurance coverage (examples):

Medicare supplement
Long-term care
Other insurance type not listed

***Important Note: If you are making a complaint on behalf of someone else, you must also provide an acknowledgement letter from the person who owns the policy granting you permission to inquire into the matter.***

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