Grievances and Appeals
We hope our members will always be satisfied with Absolute Total Care and our providers.
A member or a member’s authorized representative has the right to file a grievance or appeal.
Grievance: A grievance is an expression of dissatisfaction about any matter other than an adverse benefit determination. For more information on member grievances, please see the member page Filing a Grievance.
Appeal: An appeal is a request to change a previous decision, or adverse benefit determination, made by Absolute Total Care. This review makes us look again at the adverse benefit determination. For more information on member appeals, please see the member page Filing an Appeal.
The member must give a person or a provider acting on their behalf written permission to file a grievance or appeal. The member can give permission by completing the Appointment of Authorized Representative Form on our Member Handbooks and Forms page.
Requests for an appeal that are received without the member consent cannot be processed.
Grievance and Appeal Forms for Members and Provider Claim Issues
- Member Appointment of Authorized Representative Form (PDF)
- Member Appeal Form (PDF)
- Member Grievance Form (PDF)
- Provider Claim Adjustment/Reconsideration Form (PDF)
- Provider Dispute Form (PDF)