Grievances and appeals

You or your approved representative can file a grievance or appeal.



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. 



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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