Insurance Commissioner Complaint

SAMPLE — not a real letter. Names, amounts, and account numbers are fictional.

July 20, 2026 Jordan Sample 123 Sample Street Anytown, ST 00000 State Department of Insurance Consumer Services Division 1 Capitol Example Plaza Anytown, ST 00000 RE: Complaint against Cascade Mutual Insurance — Policy POL-0000-SAMPLE; Claim CLM-0000-SAMPLE; unanswered internal appeal Dear Consumer Services Division: I am filing a complaint against Cascade Mutual Insurance regarding its handling of a claim denial and my appeal of it. Facts. On March 3, 2026 I received an MRI of the lumbar spine (CPT 72148) ordered by my treating physician. Cascade Mutual denied the claim on March 24, 2026 as "not medically necessary," leaving me responsible for $1,870.00. On April 20, 2026 I sent a written internal appeal by certified mail (tracking 0000 0000 0000 SAMPLE), with a letter of medical necessity and my treatment records. The return receipt shows delivery on April 23, 2026. The denial notice itself stated that a decision on a post-service appeal would be issued within 60 days of receipt. As of today, 88 days after delivery, I have received no determination, no acknowledgment, and no request for additional information. I called the member services line on June 2 and July 1, 2026; on each call I was told the appeal was "in review" and given no date. Why I am complaining. My plan’s own notice set a decision timeframe, and federal rules for internal appeals under the Affordable Care Act also set timeframes for the plans subject to them. The plan has not met the timeframe it stated to me, and the delay leaves me unable to move to external review, which requires a final internal decision. In the meantime, the provider has begun billing me for the full amount. Request. I ask that the Department (1) investigate Cascade Mutual’s handling of this appeal, (2) direct the plan to issue a written determination, and (3) take whatever corrective action it finds appropriate. I would also appreciate guidance on whether the delay entitles me to proceed to external review as if the appeal had been denied. A copy of this complaint is being sent to Cascade Mutual Insurance. Please contact me at the address above. Sincerely, Jordan Sample Enclosures: EOB dated March 24, 2026; appeal dated April 20, 2026 with attachments; certified mail and return receipts; call log