Help to resolve your concern
If you have a concern, or if you want to appeal a coverage or non-coverage decision we have made, you can use the complaint and appeals process to help you get your concern resolved fairly. Follow these key steps. Some of these steps must happen within a certain time frame.
Step 1: Call or write to Member Services. We’ll do our best to resolve your concern or complaint fairly and quickly.
Step 2: You can file an appeal by mail or by calling Member Services using the number on the back of your ID card. Member Services will tell you how and let you know about any steps you must take within a certain time frame.
Step 3: In some cases, if benefits are denied at the final internal appeal level, you may have the right to ask for an independent external review.
If you have any questions regarding an appeal or grievance concerning the health care services that you have been provided, which have not been satisfactorily addressed by your plan, you may contact the Office of the Managed Care Ombudsman for assistance at 1-877-310-6560 or Ombudsman@scc.virginia.gov or by visiting their website at http://www.scc.virginia.gov. You can also write to this address:
Office of Managed Care Ombudsman
Bureau of Insurance
P.O. Box 1157
Richmond, VA 23218