How to File a Complaint with the Missouri Department of 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the 'Provider Info' section. Enter the provider's name, address, contact person, and their phone number and email. Ensure all details are clear and accurate.
3. Next, complete the 'Insured Info' section. If applicable, provide the group policy information including insured name, address, tax ID number, and employer name.
4. In the 'Info on Company/Third Party Administrator' section, input the name and address of the company or individual you are complaining about.
5. Fill out the 'Policy Information' section by selecting the type of coverage and entering relevant policy numbers and issue dates.
6. Indicate your reason for complaint by checking one of the options provided in that section.
7. Provide detailed information regarding your complaint in the 'Details of Complaint' area. Attach additional sheets if necessary.
8. Finally, sign and date at the bottom of the form. Ensure you have included any required documentation before submitting.

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