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Complaints and Grievances

If you have problems with your health plan, you can file a grievance

We hope our health plan serves you well. If you are unhappy or have a complaint, you may talk with your primary care provider, and you may call Member Services at 1-855-375-8811 (TTY 1-866-209-6421) or write to AmeriHealth Caritas North Carolina, Grievances Department, P.O. Box 7382, London, KY 40742-7382.

For Medicaid members, a grievance and a complaint are the same thing. Contacting us with a grievance means that you are you are unhappy with your health plan, provider or your health services. Most problems like this can be solved right away. Whether we solve your problem right away or need to do some work, we will record your call, your problem and our solution. We will inform you that we have received your grievance in writing. We will also send you a written notice when we have finished working on your grievance. 

You can ask a family member, a friend or a legal representative to help you with your complaint. If you need our help because of a hearing or vision impairment, or if you need translation services, or help filing out any forms, we can help you. 

You can contact us by phone or in writing:

  • By phone, call Member Services at 1-855-375-8811 (TTY 1-866-209-6421), 24 hours a day, seven days a week. After business hours you may leave a message and we will contact you during the next business day. 
  • You can write us with your complaint to AmeriHealth Caritas North Carolina, Grievances Department, P.O. Box 7382, London, KY 40742-7382.

Resolving your grievance

  • We will let you know in writing that we got your grievance within five days of receiving it. 
  • We will review your complaint and tell you how we resolved it in writing within 30 days from receiving your complaint. 
  • If your grievance is about your request for an expedited (faster) appeal, we will let you know quickly and in writing that we got your grievance. We will reply in writing within 24 hours after we get your grievance. We will review your complaint about the denial of an expedited appeal quickly. We will tell you how we resolved it in writing within five days of getting your complaint.