Grievance and Appeal

We hope you are happy with CareSource. If you are dissatisfied with a provider, disagree with a decision we have made, or are unhappy with something about our health plan, let us know. You or your appointed representative can contact us.

An appointed representative is someone you choose who can act and speak on your behalf. In order for CareSource MyCare Ohio to talk with your appointed representative, must fill out the Appointment of Representative Form. Call Member Services to have the form mailed to you. This form must be sent each time you have someone submit a grievance, appeal or request for a decision on your behalf.

You have the right to submit a:

• Coverage Determination – A decision we make about your benefits and coverage or the amount we will pay for your medical services, items, or medications.
• Organization Determination– A decision we make about the coverage of a service.
• Appeal– A request to have us reconsider and change the decision made or the action taken.
• Grievance– An official complaint. This process is used for certain types of problems such as quality of care, waiting times, receiving a bill and customer service.