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Grievances and Appeals

If you are not happy with Carolina Complete Health, or providers, or do not agree with a decision made about your services you can ask for a Grievance or an Appeal. Appeals and grievances are different.

You can contact us by phone or in writing:

  • By phone, call Member Services at 1-833-552-3876 (TTY: 711) Monday-Saturday 7 a.m. - 6 p.m. EST. After business hours you may leave a message and we will contact you during the next business day. Call Member Services at 1-833-552-3876 (TTY: 711)
  • Send a letter by mail to:

Carolina Complete Health
ATTN: Appeals and Grievance Department
P.O. Box 10353
Van Nuys, CA 91410-0353

  • In Person at:

Carolina Complete Health
1701 North Graham Street, Suite 101
Charlotte, NC 28206

You can find detailed information about grievances and appeals in our Member Handbook.

What is a Grievance?        

A grievance, or complaint, is an expression of a dissatisfaction about any matter other than an “action." If you have a problem with your health plan, care, provider, or services, you can file a complaint or grievance with the plan.

What is a Appeal?        

An appeal is a request to review a notice of adverse benefit determination decision by Carolina Complete Health. An adverse benefit determination is the denial, reduction, stopped, or limiting of health services for a member. If the Health Plan makes a decision on health service that you do not agree with, you can ask for an appeal.