Grievances and appeals in New York

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

Let us know if we made a mistake


You may want to file a grievance if:


 You're not satisfied with Anthem 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 an Anthem 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 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.


Appeal process and rights


You have the right to ask for an appeal if you don’t agree with our decision to deny or reduce a service. An appeal is when you ask us to look again at the care we denied to make sure we made the right decision. Learn more about your appeal rights:


 Medicaid appeal process


 Essential Plan appeal process


 Child Health Plus appeal process


 Health and Recovery Plan appeal process


 Managed Long-Term Care appeal process

Have questions?


Check your member handbook or live chat with a representative through the online portal or the Sydney Health app.