Bread Crumbs

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.

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Last Updated 12/16/2013