Grievance and Appeal

We hope you are happy with CareSource and the care you get. If you are unhappy or do not agree with a decision made by us or our providers, we want to know. We want to make it right. Call Member Services.

Grievances

What is a Grievance?

A grievance is a formal complaint about us, our providers, or the care you get. They do not involve the denial of benefits.

Learn more about grievances in your member handbook.

Appeals

What is an Appeal?

An appeal is when you ask us to review a decision that denied a benefit or service. You can file an appeal if you believe a decision we made adversely affects your coverage or benefits.

Learn more about appeals in your member handbook. It can tell you more about decisions, timelines, how to speed up the review, and how to extend the appeal timeframe.