Florida

STEP ONE – Notify Your Health Plan

The first thing you need to do is file a complaint with your health plan. Follow the steps below to file a complaint and appeal with your health plan:

• Call the member/customer service phone number for your health plan.
• Tell them you want to file a formal complaint and then explain the problem.
• You can also file your complaint by letter, email, or online through your health plan’s website (see below).
• If you disagree with your health plan’s decision, you have the right to file an appeal.

Below are links to the complaint forms for Florida’s top health plans:

• Aetna
• AHF – Positive Health Care Florida
• Florida Healthy Kids
• Statewide Medicaid Managed Care Assistance
• AvMed Health Plans
  • Login to your Member Portal or contact Customer Service for more information.
• Cigna
• Community Care Plan – Medicaid (see page 40)
• Health First Health Plans
  • Contact Customer Service for more information.
• Magellan Complete Care of Florida
• Prestige Health Choice
• Sunshine Health
• UnitedHealth Group
  • Log on to MyUHC.com and complete the “Appeals and Grievance Form”
  • Select: Claims and Accounts > Medical Appeals and Grievances > Member Service Request Form
  • Fax or mail the completed form to the UnitedHealthcare address listed in the instructions
• Florida Blue
• Wellcare/Staywell
• My plan isn’t listed

Medicare Plans

STEP TWO – File a Complaint

You have the right to file a complaint with the Florida Agency for Health Care Administration if you have a problem getting the services you need, including quality and affordable health care.

• The Commercial Managed Care Unit accepts health plan complaints under the Florida Agency for Health Care Administration.
• File your complaint with the Unit here.
• For more information, call the Agency’s helpline: (888) 419-3456.