Appeals & Grievances
If you believe that there was an incorrect decision made in your health care coverage with us, you have the right to request an internal informal appeal (second review). This appeal can be requested by you, an authorized person, provider or practitioner. You can request an appeal by phone, fax, email, in person or in writing to The Health Plan’s Customer Service Department. You may also provide us with any additional documents, records or information that are relevant to your appeal.
Requirements and deadlines for filing an appeal will vary depending on your benefit plan with The Health Plan. Contact us by calling 1.800.624.6961 to learn more.
The Health Plan
You can file a grievance any time that you are unhappy with The Health Plan, a provider, or if you disagree with our decision about an appeal. If you have any questions about your referral or the appeals/grievance process, please contact our Customer Service Department or click the link below to print out a form which details all the information need to file a complaint or an appeal. Send the completed form to the address or fax number listed above.
Click here to download the Member Complaint / Appeal Form.
You can make a complaint about anything that does not involve coverage or payment disputes. If your problem is about the plan's coverage or payment, please look refer to Appeal and Grievance procedures above.
To file a complaint, please call us using one of the following numbers:
- Commercial HMO, PPO or POS: 1.888.847.7902
- Medicare: 1.877.847.7907
- Medicaid: 1.888.613.8385