Appeals and grievances

How to file appeals and grievances

An appeal is a request from you or your doctor when you’d like CCA Health to re-evaluate a decision we made about what medical care, services, supplies, or prescriptions are covered.

A grievance is a complaint about any aspect of your experience with CCA Health, its providers, or vendors other than coverage or payment decisions (these issues are usually handled by the appeal process). You might file a grievance if you had any type of problem with the quality of your medical care, waiting times, or the customer service you receive. You could also file a grievance if you do not think we responded quickly enough to your request for coverage determination or organization determination, or to your appeal of that determination.

Specific procedures for filing a grievance, complaint, coverage decision, or appeal are outlined in the document below.

Appointing a representative

If you need someone to file a grievance or appeal on your behalf, you can name a relative, friend, advocate, doctor, or anyone else as your appointed representative. If you want someone to act for you, then you and that person must sign and date a statement that gives the person legal permission to act as your appointed representative. A Centers for Medicare and Medicaid Services (CMS) representative form is valid for one year from the date both parties sign the document.

If you are making a request through an appointed representative, you should download form CMS-1696 (pdf).¹ 

If you have any questions about naming your appointed representative, you can call us at 855-959-5855 (TTY 711).