Requests and complaints

Please call us first.

If you have any questions, concerns or problems with your Priority Health plan or the care you receive, contact our Customer Service department right away. Our customer service representatives can help resolve questions about:

• Benefits (including services determined to be experimental or investigational or not medically necessary or appropriate)
• Eligibility
• Payment of claims (in whole or in part)
• How we've handled payment or coordination of health care services
• Contracts with our health care providers
• Availability of care or providers
  
• Delivery or quality of health care services you received
  

Calling Priority Health is always the fastest and easiest way to settle your questions, complaints or appeals.

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Medicare Advantage and Medicare drug plan members, please note:

Medicare requires us to use a slightly different procedure for asking and answering questions and filing complaints. This procedure is explained on our Medicare website, prioritymedicare.com.
Go to the Medicare website now for information on coverage complaints and service issues.

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1. If a decision is not in your favor

If an answer you received from us about coverage or other issues does not satisfy you, customer service representatives can help you appeal our initial decisions about services or coverage we have denied, reduced or terminated.
Contact us by mail, e-mail, or phone.

2. To file a formal complaint (grievance)

If you are not satisfied with the answers you receive after talking to a customer service representative, you or someone acting on your behalf can send us a formal complaint. This formal complaint is called a grievance.
Learn how to file a grievance with Priority Health.