Grievance Form

To file a grievance, you can call us at 1-800-682-9090 (TTY 711), or submit the form below.
Required Fields
What is the reason for your grievance (formal complaint)?

If we have denied your request for a treatment, item or medication and you disagree with our decision, you can ask us to change it. That request is called an appeal. However, an appeal is different from a grievance. You can call us toll-free at 1-800-682-9090 (TTY 711) to file an appeal or if you have questions.

Have you contacted us before about this issue?
If yes, please give the date you contacted Member Services.