FILE AN APPEAL

Grievances

You may call our Member Services department for any complaint or issue you may have related to services and coverage that does not involve a denial. We will always be ready to provide you with the information you need, listen to your concerns, and resolve those concerns or problems. You may file a Grievance. Grievances may include any complaint regarding the timeliness, appropriateness, access to, and/or setting of a provided health service, procedure, or item. Grievance issues may also include complaints that a covered health service or item during a course of treatment did not meet accepted standards for delivery and health care. Contact our Member Services department by calling us toll free, at 1-866-988-2210, or if you have a hearing or speech impairment at TTY 1-800-955-1270, from 8 a.m. to 8 p.m., seven days a week.

Appeals

We also have procedures to help all members resolve their concerns related to service or medication denials and claims payment disputes. Those concerns are addressed through the Appeals process. You may file an appeal related to a denial of services, medications, claims payment, or a dispute of any amounts you must pay for services or medications you have received.

Filing an Appeal

You may file an Appeal by completing the Grievance and Appeal Form. You may do so by following the steps below:

  • Complete all sections on the form.
  • Include any information that may support your appeal.
  • Include copies of our initial denial notice and/or bills you may have received.
  • Sign the form
  • Mail or fax the form and supporting documents to:

2100 Ponce De Leon Boulevard, Suite PH1
Coral Gables, FL 33134
Fax: (305) 443-1261

Need Assistance Completing This Form?

Contact our Member Services department by calling us toll free, at 1-866-988-2210, or if you have a hearing or speech impairment at TTY 1-800-955-8770, from 8 a.m. to 8 p.m., seven days a week. One of our representatives will be more than happy to assist you. Our representatives can also provide you information on the Grievance and Appeal process as well as information on the status of a previously filed Grievance or Appeal.