Grievances and appeals in DC
You or your approved representative can file a grievance or appeal at any time.
Let us know if we missed the mark
You may want to file a grievance if:
- You’re not satisfied with Wellpoint District of Columbia, Inc. for any reason.
- You’ve had a problem with the quality of care you’ve received from our services or network providers.
- You’ve had difficulty getting access to care.
- You feel your rights and dignity have been disrespected.
- You have experienced rude behavior from a provider or a Wellpoint DC associate.
To appoint a representative to act on your behalf, please provide your written consent. Your representative can be a friend or family member, your doctor, or an attorney.
To directly submit a grievance, log into the secure enrollee portal or the SydneySM Health mobile app. You can find Grievances under the Support tab.
You can appeal if your service gets denied
If we deny, reduce, or end treatment or services, we’ll send you a Notice of Adverse Determination. It will:
- Explain why we won’t pay for the care or services your provider asked for.
- Tell you about your right to appeal our decision.
You, or your approved representative, can appeal the decision.
To directly submit your appeal form, log into the secure enrollee portal or the Sydney Health mobile app. You can find Appeals under the Support tab.
Request for Appeal forms
If you’d like to appeal in writing, please use one of the forms below:
Have questions?
Check your enrollee handbook or live chat with a representative in the Sydney Health app.
This program is brought to you by the Government of the District of Columbia Department of Health Care Finance.