OHA: Forms:

In order to assist you in investigating and appealing your claim, privacy regulations require that any party to the claim receive written permission from you granting the Office of the Healthcare Advocate authorization to obtain your medical and insurance information related to your claim.

Medical Release of Information (PDF file, 177K)

Check back soon for some sample appeal letters that you can modify for your specific case. For specific assistance with writing an appeal letter please contact the Office of the Healthcare Advocate at (866) 466-4446 or email your request to healthcare.advocate@ct.gov.

Content Last Modified on 4/9/2009 10:01:06 AM