Sample Letter of Complaint to Health Plan

Your Address
Your City, State, Zip Code


Grievance Department
Health Plan Name
Street Address
City, State, Zip Code

Dear Sir or Madam:

The purpose of this letter is to inform you of my problem with ___________ [ Briefly summarize the problem you are having. For example, "the denial of coverage for a treatment" or "a delayed payment of a claim" ]. My policy number is ______________.

My complaint concerns______________ [The reason for your complaint, followed by your explanation of what happened ]. To solve my problem, I would like _____________ [The specific action you want the plan to take].

I look forward to your reply and a resolution of my complaint.



Your Name

[Include copies  of all related records. Do not send originals.]