If you disagree with the outcome of a claim appeal or other disagreement, follow these steps.
If your concern/complaint is regarding:
- Your relationship with us, then send a letter containing the details to the address listed in your Agreement. A representative will look into your complaint and try to resolve it through an informal discussion. If you disagree with the outcome of this discussion, an arbitration proceeding may be filed.
- Our administrative procedures, then follow the procedures set forth in those benefit plans to resolve the concern or complaint. After following these procedures, if one of us remains dissatisfied, an arbitration proceeding may be filed as described in your Agreement.
- Claim payments, you must complete the claim reconsideration and appeal process as set forth in this guide before initiating arbitration.
- Your compliance with your Agreement, then we will send you a letter containing the details. If we cannot resolve the complaint through informal discussions with you, an arbitration proceeding may be filed as described in your Agreement. Arbitration proceedings will be held at the location described in your Agreement, or if a location is not specified in your Agreement, then at a location as described in the following Arbitration Locations section.
To start the arbitration process, reach out to your network account manager.
Arbitration locations:
Unless your Agreement states differently, the following list contains locations where we hold arbitration proceedings. Follow the locations where you provide care:
- AL: Jefferson County, AL
- AK: Anchorage, AK
- AZ: Maricopa County, AZ
- AR: Pulaski County, AR
- CA: Los Angeles County, CA; San Diego County, CA; San Francisco County, CA
- CO: Arapahoe County, CO
- CT: Hartford County, CT; New Haven County, CT
- DE: Montgomery County, MD
- DC: Montgomery County, MD
- FL: Broward County, FL; Hillsborough County, FL; Orange County, FL
- GA: Gwinnett County, GA
- HI: Honolulu County, HI
- ID: Boise, ID; Salt Lake County, UT
- IL: Cook County, IL
- IN: Marion County, IN
- IA: Polk County, IA
- KS: Johnson County, KS
- KY: Fayette County, KY
- LA: Jefferson Parish, LA
- ME: Cumberland County, ME
- MD: Montgomery County, MD
- MA: Hampden County, MA; Suffolk County, MA
- MI: Kalamazoo County, MI; Oakland County, MI
- MN: Hennepin County, MN
- MS: Hinds County, MS
- MO: St Louis County, MO; Jackson County, MO
- MT: Yellowstone County, MT
- NE: Douglas County, NE
- NV: Clark County, NV; Washoe County, NV; Carson City County, NV
- NH: Merrimack County, NH; Hillsboro County, NH
- NJ: Essex County, NJ
- NM: Bernalillo County, NM
- NY: New York County, NY; Onondaga County, NY
- NC: Guilford County, NC
- ND: Hennepin County, MN
- OH: Butler County, OH; Cuyahoga County, OH; Franklin County, OH
- OK: Tulsa County, OK
- OR: Multnomah County, OR
- PA: Allegheny County, PA; Philadelphia County, PA
- RI: Kent County, RI
- SC: Richland County, SC
- SD: Hennepin County, MN
- TN: Davidson County, TN
- TX: Dallas County, TX; Harris County, TX; Travis County, TX
- UT: Salt Lake County, UT
- VT: Chittenden County, VT; Washington County, VT; Windham County, VT
- VA: Montgomery County, MD
- WA: King County, WA
- WV: Montgomery County, MD
- WI: Milwaukee County, WI; Waukesha County, WI
- WY: Laramie County, WY