Appeals and Grievances
Do you have a complaint or want to appeal a decision about your health care services?
As a Colorado community Health Alliance (CCHA) member, you expect the best and that’s what we’re committed to providing you. If you have concerns about your care, call us. We’re here to help.
If you have a problem with your Health First Colorado services or providers, we would like you to tell us about it. Contact CCHA Member Support Services and we’ll try to solve the problem on the phone.
Filing a Complaint (Also Known as a Grievance)
If we can’t take care of the problem when you call us, you can file a complaint. Once you file a complaint, it will be reviewed and you will get a letter with a decision. If you do not agree with the answer you get, you may be able to ask for a second review. Learn more about filing a complaint.
Filing an Appeal
There may be times when a service that was approved will be denied, end or be reduced. In other cases, all or part of the care your provider asked for may not be paid. You will get a letter called a Notice of Action for any decision that affects your coverage or services. It will tell you the decision, why it was made and how to appeal if you disagree.
Steps to ask for an appeal
- Fill out the Member Appeal Request Form.
- Sign the form (we must have you or your designated representative’s signature to process your appeal.)
- If you would like to have a family member, friend, advocate, or provider represent you for this appeal, this person should also fill out the designated client representative section of this form.
- Mail or fax this form to:
CCHA Central Appeals Processing
P.O. Box 62429
Virginia Beach, VA 23466-2429
If you requested an appeal by phone, you must fill out, sign and mail or fax the Member Appeal Request Form to us within 10 business days of your appeal request in order for us to process your appeal.
For help filing a complaint or appeal, call:
Ombudsman for Health First Colorado Managed Care
1-877-435-7123 (toll free)
Your Health First Colorado Member Handbook will tell you more about your rights to file a complaint or an appeal. If you have questions about anything you read here or in the Member Handbook, contact CCHA Member Support Services.
File a complaint about access to behavioral health care
Your health plan is subject to the Mental Health Parity Addiction Equity Act of 2008. This means that your covered behavioral health benefits cannot be more difficult to access than physical health benefits. A denial, restriction, or withholding of behavioral health services could be a potential violation of the parity act. File a complaint with the Behavioral Health Ombudsman Office of Colorado if you have a parity concern.
A representative of the Ombudsman Office will call or reply to you directly. You can also ask your behavioral health provider or guardian/legal representative to file a complaint for you.