Appeals and Grievances

You can file a grievance if you’re unhappy with our service, plans or providers. You can also appeal a denial of payment, eligibility or other decision.


Definitions

  • Coverage Decision: A decision the plan makes about your benefits and coverage or about the amount we will pay for your medical services or drugs.
  • Reconsideration: An appeal to the plan about a medical care coverage decision.
  • Redetermination: An appeal to the plan about a Part D drug coverage decision.
  • Grievance: Any complaint or dispute expressing dissatisfaction with the plan or one of our network providers or pharmacies, including a complaint about the quality of your care.
 Filing an Appeal
 Filing a Grievance
 Appointing a Representative
 Time Frame for Filing Appeals and Grievances
 Non-Contract Provider Appeal Rights
 Additional Information
 Quality Improvement Organization

Updated November 1, 2019
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