All members have the right to appeal any Monarch Healthcare decision. All appeals must proceed through the members contracted health plan.

Appeals:

Written or verbal requests to reconsider the initial determination of a denied healthcare service or claim.

A member may request an appeal by:

  • Written or Verbal notification to their Health plan representative to appeal any decision they feel is unfair or unjust. 
  • Written or Verbal notification to the Monarch healthcare Contracted provider (Physician) to appeal a decision.
  • Fax, Written or Verbal notification of an appeal through the Customer Service Department  of Monarch HealthCare at (888) 767-2222. All verbal, written or faxed appeals will be directed to the member’s specific health Plan.

Grievances:

Complaint or inquiry - A member’s written or verbal request for information, assistance or concern with an issue. A complaint can become a grievance.
Grievance – The written or verbal expression of a member’s dissatisfaction with the care or services provided, and may be utilized to request review of a complaint/issue that has not been resolved to the member’s satisfaction.

  • The member submits a complaint or grievance to the Customer Service  Department of Monarch HealthCare at (888) 767-2222 or the member’s specific Health Plan either verbally or in writing. If given to Monarch Healthcare, the complaint or grievance will be forwarded to the member’s health plan as well as be reviewed for quality of care or quality of service issues by the Quality Management Specialist who will then work on a resolution of the issue.

 

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