Complaints, grievances, appeals and fair hearings
There may be a time when you are unhappy with the care or services you receive from AmeriHealth Caritas District of Columbia (DC). There are several things you can do to report your issue. The ways to report an issue are described below.
Complaints and grievances
If you are unhappy with something that happened to you when you received health care services, you can file a complaint/grievance. Examples of why you might file a complaint/grievance include:
- You feel you were not treated with respect.
- You are not satisfied with the health care you got.
- It took too long to get an appointment.
You should file a complaint/grievance as soon as possible and no later than 90 days after the event about which you are unhappy. AmeriHealth Caritas DC will usually give you a decision within 30 days, but no later than 44 days, but may ask for extra time to give a decision.
To file a complaint/grievance, you should call Member Services at 1-202-842-2810 or toll-free at 1-866-842-2810. Your doctor can also file a Complaint/Grievance for you.
To file a complaint/grievance in writing, use the address or fax number below.
AmeriHealth Caritas District of Columbia
Member Service Grievance Dept.
200 Stevens Drive
Philadelphia, Pa 19113
Fax Number: 1-202-408-8682
Appeals and fair hearings
If you believe your benefits were unfairly denied, reduced, delayed or stopped, you have a right to file an appeal with AmeriHealth Caritas District of Columbia (DC) and request a "fair hearing" with the D.C. Office of Administrative Hearings.
- To file an Appeal with AmeriHealth Caritas DC, call Member Services at 1-202-842-2810 or toll-free at 1-866-842-2810.
- To file a request for a fair hearing, call or write the District government at:
District of Columbia Office Administrative Hearings Clerk of the Court
441 4th St., NW
Washington, DC 20001
Telephone Number: 1-202-442-9094
You must file an appeal or request a fair hearing within 90 days of the date you receive AmeriHealth Caritas DC’s Notice of Action.
If you want to continue receiving the benefit during your fair hearing or appeal, you must request the fair hearing or appeal within the later of the following:
- 10 days from the postmark of the AmeriHealth Caritas DC’s Notice of Action or
- By the intended effective date of the AmeriHealth Caritas DC's proposed action (or, in other words, when the benefit is to stop)
Your provider may file an appeal or request for a fair hearing on your behalf if you give permission.
For more information regarding appeals, expedited (emergency) complaints, grievances, and the appeals process, view your member handbook. You can also call member services at 1-202-842-2810 or toll-free at 1-866-842-2810.