Grievances and appeals

Grievances

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. 

Appeals

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)

  Appeal consent form (English)

  Appeal consent form (Spanish)