Apple Health grievances and appeals
Your rights and things you can do if you have any issues with your Apple Health Managed Care Plan.
Contents
1. Why grieve or appeal
If you’re on an Apple Health Managed Care plan, you might at some point disagree with something that someone in the plan tells you. Or you might feel something isn’t right.
Maybe the plan refuses to cover a service you need, or you want to stay with a doctor who’s dropping out of your plan. You might feel you’ve been treated unfairly by a provider or the plan.
If there’s anything about your plan or your health care that you’re not satisfied with, your managed care plan’s Member Handbook briefly discusses your options. We explain it all here in more detail. We also explain your rights when you need a faster (“expedited”) decision.
Keep a written record of what you asked for, when, and how, a copy of anything you sent in writing, and any response or records you get.
Read any written notice the plan sends you about a decision it made that is unfavorable to you. Make sure you understand its reason. Note any deadlines.