File a Complaint

We hope you will be happy with CareSource and the service we provide. If you are unhappy with anything about CareSource or its providers you should contact us as soon as possible. This includes if you do not agree with a decision we have made. You, or someone you want to speak for you can contact us. If you want someone to speak for you, you will need to let us know this. CareSource wants you to contact us so that we can help you. To contact us, you can:

  • Call the Member Services Department at 1-800-993-0780 (TTY: 1-800-750-0750 or 711); or
  • Fill out the form in your Member Handbook; or
  • Call Member Services Department to request they mail you a form; or
  • Write a letter telling us what you are unhappy about. Be sure to put your first and last name, the number from the front of your CareSource member ID card, and your address and telephone number in the letter so that we can contact you, if needed. You should also send any information that helps explain your problem.

Mail the form or your letter to:

CareSource
Attn: Grievance Department
PO Box 1947
Dayton, OH 45401-1947

CareSource will send you something in writing if we make a decision to:

  • Deny a request to cover a service for you;
  • Reduce, suspend or stop services before you receive all of the services that were approved; or
  • Deny payment for a service you received that is not covered by CareSource.

We will also send you something in writing if, by the date we should have, we did not:

  • Make a decision on whether to okay a request to cover a service for you; or
  • Give you an answer to something you told us you were unhappy about.

If you do not agree with the decision/action listed in the letter, and you contact us within 90 calendar days to ask that we change our decision/action, this is called an appeal. The 90 calendar day period begins on the day after the mailing date on th letter. Unless we tell you a different date, we will give you an answer to your appeal in writing within 15 calendar days from the date you contacted us. If we have made a decision to reduce, suspend or stop services before you receive all of the services that were approved, your letter will tell you how you can keep receiving the services if you choos and when you may have to pay for the services. You can also appeal by phone or in writing. You can submit information to help you explain your case if you want.

If you contact us because you are unhappy with something about CareSource or one of our providers, this is called a grievance. CareSource will give you an answer to your grievance by phone (or by mail if we can't reach you by phone) within the following time frames:

  • 2 working days for grievances about not being able to get medical care
  • 30 calendar days for all other grievances except grievances that are about getting a bill for care you have received.
  • 60 calendar days for grievances about getting a bill for care you have received.

If you are not happy with our answer to your grievance, you can ask us to reconsider it. To do so, you must call or send a letter to CareSource within 15 working days of getting our answer/decision about your grievance. A meeting will be held within 10 working days from the date CareSource gets your request. You, and/or someone you have chosen to represent you, can be at the meeting and present information. CareSource will send you an answer by certified mail within three working days of the meeting.

You also have the right at anytime to file a complaint by contacting the:

Ohio Department of Job and Family Services
Bureau of Managed Health Care
P.O. Box 182709
Columbus, Ohio 43218-2709
1-800-605-3040 or 1-800-324-8680
(TTY: 1-800-292-3572)
Ohio Department of Insurance
50 W. Town Street
3rd Floor - Suite 300
Columbus, Ohio 43215
1-800-686-1526

State hearings

CareSource will notify you of your right to request a state hearing when:

  • A decision is made to deny services
  • A decision is made to reduce, suspend, or stop services before all of the approved services are received
  • A provider is billing you because CareSource has denied payment of the service

At the time CareSource makes the decision, or is aware that the provider is billing you for payment, we will mail you a state hearing form. If you want a state hearing, you must request a hearing within 90 calendar days. The 90 calendar day period begins on the day after the mailing date on the hearing form. If we have made a decision to reduce, suspend, or stop services before all of the approved services are received and you request the hearing within 15 calendar days from the mailing date on the form, we will not take the action until all approved services are received or until the hearing is decided, whichever date comes first. You may have to pay for services you received after the proposed date to reduce, suspend, or stop services if the hearing officer agrees with our decision.

To request a hearing you can sign and return the state hearing form to the address or fax number listed on the form, call the Bureau of State Hearings at 1-866-635-3748, or submit your request via e-mail at bsh@jfs.ohio.gov. A state hearing is a meeting with you, someone from the County Department of Job and Family Services, someone from CareSource and a hearing officer from ODJFS. CareSource will explain why we made our decision and you will tell why you think we made the wrong decision. The hearing officer will listen and then decide who is right based upon the information given and whether we followed the rules. If you want information on free legal services but don't know the number of your local legal aid office, you can call the Ohio State Legal Services Association at 1-800-589-5888, for the local number.

State hearing decisions are usually issued no later than 70 calendar days after the request is received. However, if the MCP or Bureau of State Hearings decides that the health condition meets the criteria for an expedited decision, the decision will be issued as quickly as needed but no later than three working days after the request is received. Expedited decisions are for situations when making the decision within the standard time frame could seriously jeopardize your life or health or ability to attain, maintain, or regain maximum function.