Virginia

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 Virginia’s top health plans:

Medicare Plans

 

STEP TWO – File a Complaint

You have the right to file a complaint with the State Corporation Commission of the Commonwealth of Virginia if you have a problem getting the services you need, including quality and affordable health care. To file a complaint you must first complete your health plan’s appeal process.

  • If you need assistance in appealing your health plan’s decision, you can contact the Office of the Managed Care Ombudsman. For the Office to help with an appeal, you must complete a Life and Health Insurance Complaint/Appeal Form here.
  • Call the Office’s helpline: (877) 310-6560, select option 1.
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Know Your Rights

State and federal law protects your rights. When you sign up for a health plan and/or if you have problems accessing care through your health plan, it is important to know your rights.