Complaints and Grievances

If you have a problem with your health plan, care, provider or services, you can file a complaint with the plan. This is called a grievance.

Types of grievances include:

  • Dissatisfaction with the quality of care or services you receive.
  • Dissatisfaction with the way you were treated by the plan or its network providers.
  • If you believe your rights are not respected by AmeriHealth Caritas New Hampshire or its network providers.
  • Dispute of an extension of time proposed by the plan to make an authorization decision.

Most problems can be solved right away. Problems that are not solved right away over the phone and any complaint that comes in the mail will be handled according to our complaint procedures described below.

How to file a complaint

If you are unhappy with your health plan, provider, care or your health services, you can file a complaint (also called a grievance). You can file a complaint by phone or in writing at any time.

  • To file by phone, call Member Services at 1-833-704-1177 (TTY 1-855-534-6730), 24 hours a day, seven days a week.
  • To file in writing, you can write us with your complaint to:
    AmeriHealth Caritas New Hampshire
    Grievances Department
    PO Box 7389
    London, KY 40742-7389.

You may designate someone to file the grievance for you, including your provider. However, you must give written permission to have your provider or another person file a grievance for you. If you need our help because of a hearing or vision impairment, or if you need translation services, or help filing out the forms, we can help you. We will not make things hard for you or take any action against you for filing a complaint.

You can also contact the New Hampshire Department of Health and Human Services (NH DHHS) Customer Service Center at 1-844-ASK-DHHS (1-844-275-3447) (TDD Access Relay: 1-800-735-2964), Monday through Friday, 8 a.m. – 4 p.m. ET. for help with problems you have with your health plan, care, provider or services. They will be able to assist you with your grievance.

What happens next

AmeriHealth Caritas New Hampshire will respond to your grievance as fast as your health condition requires, but no later than 45 calendar days from the date we receive it. For grievances about clinical matters, we will respond in writing.

For grievances unrelated to clinical matters, we may respond orally or in writing. You do not have the right to appeal your grievance. However, you have the right to voice concerns to NH DHHS if you are dissatisfied with the resolution of your grievance. Contact the NH DHHS Customer Service Center at 1-844-ASK-DHHS (1-844-275-3447) (TDD Access Relay: 1-800-735-2964), Monday through Friday, 8 a.m. – 4 p.m. ET.

Members