Health Care Appeals Transmittal Form


Arizona Department of Insurance
100 North 15th Avenue, Suite 261

Phoenix, AZ  85007-2630

Starting July 1, 2020, we will be the
Department of Insurance and Financial Institutions (DIFI).

This document must accompany each appeal submitted to the Arizona Department of Insurance.  An appeal can only be submitted to the Department after the insurer's appeals process has been exhausted.