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Complaints and Grievances

As an AmeriHealth Caritas Iowa member, you have the right to file a grievance.

We hope you are happy with your health care and our health care providers. But, if you have questions or concerns about your benefits or services, call Member Services at 1-855-332-2440 (TTY 1-844-214-2471) 24 hours a day, 7 days a week.

We will look into your issue if we can’t fix it. We will respond to you within 30 days. If you are still not happy, you have the right to:

Complaints

You can complain if you feel we violated your rights. Call us at 1-855-332-2440 (TTY: 1-844-214-2471).

You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights. Call them at 1-877-696-6775. Or, send a letter to:

200 Independence Avenue, S.W.
Washington, D.C. 20201

We will not retaliate against you for filing a complaint.

Grievances

What is a grievance?

A grievance is a way for you to tell us that you are not happy about your care.

If you are not happy with a decision we made about your health care, file an appeal and not a grievance.

Grievance system

AmeriHealth Caritas Iowa’s grievance system has:

  • A grievance process, where you can submit a grievance or complaint.
  • An appeal process, where you can appeal a decision we made to deny or limit services.
  • A fair hearing process, where you can submit your grievance or appeal before the state in a fair hearing. Each of these processes is explained in this section.

Why file a grievance?

  • You are not happy with your quality of care.
  • Someone from AmeriHealth Caritas Iowa or from your provider’s office was rude.
  • You believe AmeriHealth Caritas Iowa or an Iowa provider violated your rights.

How to file a grievance

You can file a grievance by phone or in writing.

You should file a grievance as soon as you can. You should always file no later than 90 days after the event that caused you to be unhappy.

We will send you a letter within 3 business days to let you know we got your grievance.

After we are done with our research and within 30 business days of getting your grievance, we will send you another letter with the outcome.

We may extend the review time frame by a 14 more business days. If we do, we will send you a letter that explains the delay.

You can file a grievance in two ways:

  • By phone: call Member Services at 1-855-332-2440 (TTY 1-844-214-2471). You can call 24 hours a day, 7 days a week.
  • By mail:

Complaints and Grievances Department
PO Box 7116
London, KY 40742
ATTN: Complaints and Grievances

Your provider can file your grievance for you. But, you must say so in writing.