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Complaints / Grievances

If you ever have a concern with any part of your health care, or you are not happy with the services you are receiving from Health Choice Insurance Co., please contact us. We have an established grievance (or formal complaint) process in place for you to address any concerns you have about your care or services.

This process gives you a chance to express any frustration or dissatisfaction with the quality of care you receive, the manner in which that care was provide to you, difficulty in getting items, the quality of care or services you received, or the way you are treated by anyone involved in your health care.

You can file a grievance either over the phone or in writing by letter or fax. You must file your complaint within 90 days of the event for it to be considered.

To file by phone, just call Member Services and a Representative will help you. We will ask you about the concern. Please be sure to give us details about the matter, including the date(s) the problem happened and any other facts that would help us to resolve the issue for you.

To file a grievance in writing, please send your letter to:

Health Choice Insurance Co.
Attn: Member Grievances
410 N. 44th St., Suite 928
Phoenix, AZ 85008
 
Or, you may submit your request by fax at: 480-760-4739

Appeals

Health Choice Insurance Co. may deny services that your doctor asks for through our Prior Authorization process, or Health Choice Insurance Co. may limit or stop care we said you could have. If this happens, you will get an action letter from Health Choice Insurance Co. This is called a “Notice of Action”, or “Adverse Benefit Determination”.

The Notice of Action letter will explain the decision Health Choice Insurance Co. made and will include:

  • The law, rule or policy that was used to make the decision
  • The date that Health Choice Insurance Co. made the decision
  • How to ask for a second review if you do not agree with the decision (also called an appeal)
  • How to continue receiving services during the appeal process

The Notice of Action will also explain that if you lose the Appeal, you will have to pay for the services you got during the Appeals process. Before filing an Appeal, check with your doctor. Your doctor could have a different plan of care or service that may be covered. This may include other treatments you can get that will have the same result.

For complete information on what can and cannot be appealed and the member Appeals process, see the Grievance and Appeals Process Information Packet.

Complaints & Grievances

Health Choice Insurance Co.

For information and assistance, call toll-free: 1-855-452-4242

To obtain language or ASL interpretation services for your medical care: 1-855-452-4242

TTY/TDD: 711

You may also contact us by e-mail at

HOURS OF OPERATION

Member Services
Monday – Friday (except holidays),
8 a.m. – 5 p.m.

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