Resolve complaints through Member Services

If you need to call the Health Plan to question a decision we made that you are unhappy about, a Member Services representative may be able to resolve your concern. However, if you are not satisfied with the result, the Member Services representative can help you file a complaint or a grievance and will explain the process to you.

You may file a grievance when you want the Health Plan to reconsider a decision concerning the medical necessity and appropriateness of a health care service.

You may file a complaint when you have a dispute or problem regarding a provider, or the coverage, operations, or management policies of the Health Plan. Complaints can involve quality of care, quality of service, benefits exclusion, claim denials, and other similar matters.

Your Member Handbook explains the complaint and grievance process in detail. If you would like to talk to a Member Services representative, call the number on the back of your member ID card. TTY users should call 1-800-361-2629.