Ensuring You Receive the Service You Deserve

At Network Health, we want to ensure you receive the service you need and deserve. If you have concerns, we want to make sure you understand all your options. If you do not agree with Network Health’s decisions about your care or what’s covered, you have the right to file an appeal or grievance. We have a team of appeals and grievance specialists who will work with you throughout this process.

When do I ask for a reconsideration? If you would like to request a reconsideration—which is a re-review of your claim—you may call our member experience team at the number listed on the back of your member ID card.

If you request a claim review, Network Health will complete a second review of your claim and will provide you a decision once the review is complete.

If Network Health still denies your claim—referred to as upholding the denial—you will receive a written notification with the specific reason(s) for the continued denial.

When do I file a grievance? You have the right to file a grievance if you do not agree with Network Health’s decisions about your health care. You can submit a grievance in writing within 60 calendar days of the date you receive a claim denial. Your written grievance should include your full name, member ID and detailed information about the decision you would like reviewed. You may also include any comments, documents, records or other information you would like Network Health to consider in its review.