Grievances and appeals in NJ FamilyCare

 

You or your approved representative can file a grievance or appeal at any time.

Let us know if we missed the mark

 

You may want to file a grievance if:

 

You're not satisfied with Wellpoint for any reason.

 

You've had a problem with the quality of care you’ve received from our services or network providers.

 

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.

 

You can file a grievance by:

 

Logging into the online portal or the mobile app and finding Grievances under Support.

 

Printing and faxing the form to us at 877-271-2409.

You can appeal if your service gets denied

 

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:

 

English 

 

Spanish 

Have questions?

 

Check your member handbook or live chat with a representative in the Sydney Health app.

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