About Appeals and Grievances
If you’re facing an issue with Jefferson Health Plans, please contact Member Relations at 1-833-422-4690 (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, or if you are disputing any cost sharing amounts you owe for an item or service, or a rescission of coverage decision, 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.
1Verbal Appeal or Grievance
You can call Member Relations at 1-833-422-4690 (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
April 1 – September 30, we’re available 8 a.m. – 8 p.m. Monday through Friday
2Written Appeal or Grievance
You can send your appeal or grievance in writing to:
Attn: Member Appeals Department/CGA 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 Appeal and it is outside of normal Member Relations hours of operation, please fax your expedited request to 215-991-4105. See appeal forms below.
For Members: To appeal to Jefferson Health Plans use the internal appeal request form. To appeal to the Pennsylvania Insurance Department use the external appeal request form.
For Providers: expedited appeal request form