If you are dissatisfied with your plan or any of its employees, providers, or contractors, or your plan´s services, determination of benefits, or the health care treatment received through the plan, you can file a complaint or grievance with your plan. You may make your complaint/grievance verbally or in writing. You may also designate someone to make the complaint/grievance for you.

Refer to your member handbook to learn how to use the plan´s complaint/grievance process or call the plan´s member services or complaint/grievance phone line listed on your health plan identification card. Managed care plans certified by the Department of Health must have a process to receive and respond to complaints and grievances. Many issues can be resolved with a phone call to your plan.

Managed care enrollees and providers can file a complaint with certain government agencies. Depending on the type of health care plan involved and the kind of complaint, there are different agencies that can help. You do not have to file a complaint with your plan before you speak with or write to a government office.

The office you contact may ask you to complete a form to file your complaint. If you make a verbal complaint, you may be asked to send written information or documents to support your complaint. If you designate someone to make the complaint for you, you may be asked to sign a written authorization form to allow the government to share your personal health care information with your designee.

Once all needed information is received, the agency will review or investigate the complaint. The agency may work with the health care plan to correct the problem, and may check if any laws or regulations were violated. The agency will inform you of how the complaint was resolved.

To file a complaint, find your issue on the chart below and contact the government agency listed through the phone number, web site or mailing address provided.