File a Grievance
You can file a grievance when:
- you have a complaint about the quality of the care you received,
- a provider or facility behaved inappropriately, or
- you have any other non-appealable issue.
A sponsor, parent or guardian or other representative may file on behalf of a dependent child.
To File a Grievance
Mail written notice of your grievance to the appropriate contractor and be sure to include the following:
- Your name, address and telephone number
- Your Sponsor's Social Security number
- Your date of birth
- Your signature
- A description of the issue or concern that must include:
- Date and time of the event
- Name of the provider(s) and/or person(s) involved
- Location of the event (address)
- The nature of the concern or complaint
- Details describing the event or issue
- Any appropriate supporting documents
Note: If you are filing a grievance on behalf of a dependent, provide the dependent's information, as well as your own in the grievance.
Select Your Contractor