Medicare Appeals and Grievances

CareFirst Advantage encourages our members to let us know if they have questions, concerns, or problems related to covered services or the care that they receive. Members are encouraged to first contact Member Services at 855-290-5744 for assistance. For information about the rules for making complaints in different situations, please review the information in this section.

Federal law guarantees a member’s right to make complaints regarding concerns or problems with any part of their medical care as a plan member. The Medicare program has set forth requirements for the filing and processing of member complaints. If a member or authorized representative files a complaint, we are required to follow certain processes when we receive it. We must be fair in how we handle it, and we are not permitted to disenroll or penalize a member in any way for making a complaint. Read the Appeals and Grievances in Chapter 10 of our provider manual.