Grievance and Appeals
Member's Grievance and Appeal Rights with the Health Plans
Under QUEST Integration, select the preferred language and go to pgs. 66-71 of the member handbook.
Kaiser Permanente Member Handbook
No link for member grievances and appeals but the information is found in the member handbook.
UnitedHealthcare Community Plan
Click on 'Member resources' towards the bottom of the webpage.
Applicant's Appeal Rights
If you do not agree with the foregoing determination, you may call, write, use other commonly available electronic means, or visit the Med-QUEST Eligibility Branch to request an informal review meeting with the eligibility worker and/or his/her supervisor. In addition, you may request an administrative hearing with a Hearing Officer. You will be given the opportunity to present evidence in support of your position that the intended action is incorrect. You do not need to first have an informal review meeting in order to request an administrative hearing.
You must make your request for either an informal review or an administrative hearing in-person, by telephone, mail, or through other commonly available electronic means. If you wish to submit a written request, you may use the Department’s form or write your request on any paper. Your request must be received by our office within 90 calendar days from the date of this notice.
You may have someone else request, or speak, for you at the informal review or administrative hearing. This person is called an authorized representative. If you did not designate an authorized representative on your application, please provide written authorization for the person to represent you or you may use the Department’s Request for a Hearing form. The written authorization must be received by the Med-QUEST Eligibility Office in order to acknowledge any actions taken by your authorized representative. An authorized representative must agree to maintain, or be legally bound to the confidentiality of any information regarding the applicant or beneficiary that is provided by the department. An authorized representative who is a provider, staff member or volunteer of an organization must agree to sign an agreement to comply with regulations relating to confidentiality of information, prohibition against reassignment of provider claims as appropriate for a health facility or an organization acting on the facility’s behalf; must meet the authentication and data security standards required under State and federal law or otherwise specified by the department. If you choose to have an authorized representative, you may withdraw his or her name or replace the person with another authorized representative at any time.
At the informal review meeting or at the administrative hearing, you and/or your authorized representative will have the opportunity to explain why you do not agree with the decision. At your request, our office will provide you with information about a Legal Aid Office that may be able to advise or represent you at no cost. Please let us know if you need an interpreter or other aid to help you communicate with us at the informal review or administrative hearing.
H.A.R. 1703.1-2 & 1703.1-3
Department of Human Services Med-QUEST Division
P.O. Box 700190