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Member Resources

Grievances and Appeals

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As a Jefferson Health Plans member, you have the right to appeal a decision we’ve made about your coverage or submit a formal complaint.

Contents:

About Appeals and Grievances

If you’re facing an issue with Jefferson Health Plans, please contact Member Relations at 1-866-901-8000 (TTY 1-877-454-8477) and we will work to resolve the issue.

If you believe that Jefferson Health Plans should pay for a service or benefit that has been denied, in whole or in part, you have the right to appeal the decision. If you have any other type of complaint or problem with our plan, you can file a grievance.

How to Contact
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Verbal Appeal or Grievance

You can call Member Relations at 1-866-901-8000 (TTY 1-877-454-8477) to file a verbal appeal or grievance.

October 1 – March 31, we’re available 8 a.m. – 8 p.m. seven days a week (closed on Thanksgiving and Christmas).

April 1 – September 30, we’re available 8 a.m. – 8 p.m. Monday through Friday

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Written Appeal or Grievance

You can send your appeal or grievance in writing to:

Attn: Complaints, Grievances & Appeals Unit
Jefferson Health Plans
1101 Market Street, Suite 3000
Philadelphia, PA 19107

Grievances and appeals can also be faxed to 215-991-4105. If you would like to file an Expedited Grievance or Appeal and it is outside of normal Member Relations hours of operation, please fax your expedited request to 215-991-4105.

Additional Resources

Appointment of a Representative

View Form
Medicare Complaint Form
View PDF
Medicare Ombudsman
View PDf