Grievances and Appeals
If you are not happy with Carolina Complete Health, or providers, or do not agree with a decision made about your services you can ask for a Grievance or an Appeal. Appeals and grievances are different.
A grievance, or complaint, is an expression of a dissatisfaction about any matter other than an “action." If you have a problem with your health plan, care, provider, or services, you can file a complaint or grievance with the plan.
An appeal is a request to review a notice of adverse benefit determination decision by Carolina Complete Health. An adverse benefit determination is the denial, reduction, stopped, or limiting of health services for a member. If the Health Plan makes a decision on health service that you do not agree with, you can ask for an appeal.
You can ask a family member, a friend, a legal representative, or your provider/doctor to request a complaint or appeal on your behalf. 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 1-833-552-3876 (TTY: 711) Monday-Saturday 7 AM - 6 PM EST. After business hours you may leave a message and we will contact you during the next business day. Call Member Services at 1-833-552-3876 (TTY: 711)
- Send it electronically by fax to 1-833-318-7256
- Email us.
- Send a letter by mail to:
Carolina Complete Health
ATTN: Grievance and Appeals
Address: 10101 David Taylor Drive, Suite 300
Charlotte, NC 28262
You can find detailed information about grievances and appeals in our Member Handbook.