Grievances, Appeals and State Fair Hearings
We hope that you will always be satisfied with AmeriHealth Caritas Louisiana and our health care providers. If you have questions or concerns about your AmeriHealth Caritas Louisiana benefits or services, call Member Services at 1-888-756-0004 (TTY 866-428-7588).
Our Member Services representatives can help with most questions and concerns. If you are still not happy, you do have the right to file a grievance, appeal or a state fair hearing. Please call Member Services if you need help or have questions about filing a grievance, appeal or state fair hearing.
A member grievance is an oral or written report of when you are not satisfied with AmeriHealth Caritas Louisiana and include:
- The quality of care you received
- The quality of service you received
- Rudeness of a health care provider or a network employee
- Network administration practices other than an action
Additional information, such as how to file a member grievance, is available in the member handbook.
An appeal is a request for review of an action.
An action is a decision, including the approval, reduction or denial of a requested service, made by AmeriHealth Caritas Louisiana.
If you are not happy with a decision made by AmeriHealth Caritas Louisiana regarding the medical necessity or appropriateness of services requested, you may file an appeal with us. For more information, such as how to file an appeal, see your member handbook.
You have the right to continue benefits while an Appeal is pending. You may call AmeriHealth Caritas Louisiana and ask that your benefits continue. The toll-free number is 1-888-756-0004. You must ask for this within 10 calendar days from the mail date of AmeriHealth Caritas Louisiana's denial letter.