Grievance & Appeals
If you’re having a problem getting care or services, we want to hear about it! You can file a complaint (also called a grievance) with us. Learn more about grievances below.
If we sent you a letter saying you can’t get certain care or services, you can submit an appeal. Learn more about appeals below.
Grievances
You or someone on your behalf may file a grievance if:
- You're not satisfied with Amerigroup for any reason
- You've had a problem with our services or network providers with things like the quality of care they provide
- You've had difficulty getting access to care
- You feel your rights and dignity have been disrespected
- You have experienced rude behavior from a provider or an Amerigroup associate
To appoint a representative to act on your behalf, please provide your written consent. Your representative can be a friend or family member, your doctor or an attorney.
Filing a grievance with Amerigroup
To file a grievance:
-
Call us: Member Services: 1-800-600-4441 (TTY 711)
Talk to someone at the plan by calling 515-327-7012 (TTY 711). -
Write to us — Send a letter to:
Grievance and Appeals Department
Amerigroup Iowa, Inc.
4800 Westown Parkway, Ste. 200
West Des Moines, IA 50266
In your letter, include the date of the problem and the people involved.
Appeals
If we deny, reduce or end treatment or services, we’ll send you a Notice of Adverse Determination. It will:
- Explain why we won't pay for the care or services your provider asked for
- Tell you about your right to appeal our decision
You or your approved representative can appeal the decision.
You must file for an appeal within 60 calendar days from the time you get the Notice of Adverse Determination.
You can appeal our decision orally or in writing:
- Call Member Services at 1-800-600-4441 (TTY 711), or talk to someone at the plan by calling
515-327-7012 (TTY 711). - Send a letter to the address below including all information you’d like us to consider:
Grievance and Appeals Department
Amerigroup Iowa, Inc.
4800 Westown Parkway, Ste. 200
West Des Moines, IA 50266
If you file the appeal by phone, you must follow up in writing within 10 calendar days of the date you called us. You may send a letter or fill out the Request for Appeal Form.
- hawk-i Request for Appeal form - English
- hawk-i Request for Appeal form - Spanish
- IA Health Link Request for Appeal form - English
- Iowa Health Link Request for Appeal form - Spanish
- Authorized Representative for Managed Care Appeals form -- English
- Authorized Representative for Managed Care Appeals form -- Spanish
If you don't follow up in writing, your appeal will stop. We’ll send a letter letting you know we’ve stopped the appeal process.
See your member handbook to learn more.
