Grievances

As an AmeriHealth Caritas Delaware member, you have the right to file a grievance. A grievance is a complaint that you make to your plan about how you feel about your health care.

We hope you are happy with your health care and our health care providers. But, if you have questions or concerns about your benefits or services, call AmeriHealth Caritas Delaware Member Services, 24 hours a day, seven days a week, at:

  • Diamond State Health Plan: 1-844-211-0966 (TTY 1-855-349-6281).
  • Diamond State Health Plan-Plus: 1-855-777-6617 (TTY 1-855-362-5769).

We will look into your issue if we can’t fix it. We will respond to you within 30 days.

Complaints

You can complain if you feel we violated your rights. Call AmeriHealth Caritas Delaware Member Services, 24 hours a day, seven days a week, at:

  • Diamond State Health Plan: 1-844-211-0966 (TTY 1-855-349-6281).
  • Diamond State Health Plan-Plus: 1-855-777-6617 (TTY 1-855-362-5769).

You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights. Call them at 1-877-696-6775. Or, send a letter to:

200 Independence Avenue, S.W.
Washington, DC 20201

We will not retaliate against you for filing a complaint.

What is a grievance?

A grievance is a complaint that you make to AmeriHealth Caritas Delaware about how you feel about your health care.

File an appeal and not a grievance if you are unhappy about a decision we made to deny or limit services.

Grievance system

AmeriHealth Caritas Delaware’s grievance system has:

  • A grievance process, where you can submit a grievance or complaint.
  • An appeal process, where you can appeal a decision we made to deny or limit services.
  • A fair hearing process, where you can submit your grievance or appeal before the state in a fair hearing. Each of these processes is explained in this section.

Why file a grievance?

  • You are not happy with your quality of care.
  • Someone from AmeriHealth Caritas Delaware or from your provider’s office was rude.
  • You believe AmeriHealth Caritas Delaware or a Delaware provider violated your rights.

How to file a grievance

You or a personal representative can file a grievance by phone or in writing.

You should file a grievance as soon as you can. You may file a grievance at any time.

We will send you a letter within five business days to let you know we got your grievance.

After we are done with our research and within 30 business days of getting your grievance, we will send you another letter with the outcome.

We may extend the review time frame by 14 more business days. If we do, we will send you a letter that explains the delay.

You can file a grievance in two ways:

  • By phone: Call AmeriHealth Caritas Delaware Member Services, 24 hours a day, seven days a week, at:
    • Diamond State Health Plan: 1-844-211-0966 (TTY 1-855-349-6281).
    • Diamond State Health Plan-Plus: 1-855-777-6617 (TTY 1-855-362-5769).
  • By mail:

AmeriHealth Caritas Delaware
Complaints and Grievances Department
P.O. Box 80102
London, KY 40742-0102

Your provider can file your grievance for you. But, you must say so in writing.

Members