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How and When to File an Appeal

What is an Appeal?

An appeal is not the same as a complaint or grievance. If you do not agree with a decision or action made by CareSource in regard to your medical care, you have the right to appeal. An appeal is a request to reconsider and change the decision made or the action taken.

You have the right to appeal when:

  • CareSource denies a service.
  • CareSource gives partial approval to cover a service.
  • CareSource denies payment of a service.