Grievance - Horizon NJ Health

Grievance Form

To file a grievance, you can call us at 1-800-682-9090 (TTY 711), or submit the form below.

Required Fields

First Name

Last Name

Member ID #

Best phone to reach you

Email Address

What is the reason for your grievance (formal complaint)?

1. Difficulty making an appointment

2. Dissatisfaction with the way a provider or their staff treated me

3. A provider refused to see me because of claims payment issues with the plan

4. Difficulty getting services authorized

5. I was billed for covered services

6. Dissatisfaction with the way health plan staff treated me

If you chose 1, 2, or 3 above, specify provider

Additional Information (optional)

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.

Yes

Date (DD/MM/YY)