Grievances and appeals

Grievances

 

You or someone on your behalf may file a grievance if:

 

  •  You're not satisfied with Wellpoint for any reason.
  •  You've had a problem with our services or network providers with things like the quality of care they provide.
  • 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 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. 

Appeals

 

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.

 

Learn more about your grievance and appeal rights:

 

  Grievance and appeal rights (English)

  Grievance and appeal rights (Spanish)

Have additional questions?

 

View your member handbook or chat with a representative.

 

  Member handbook (English)

  Member handbook (Spanish)

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