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Grievances & Appeals

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Appeals and Grievances

We are dedicated to addressing your concerns and resolving them promptly. As a member of Scott and White Health Plan (SWHP), you have the right to request an appeal, and file a grievance.

Appeal

An appeal is a request you may make for reconsideration of our determination on a service, supply or drug you have received or requested. You may file an appeal when you believe that the services or supplies should be covered or that they should be covered differently than SWHP approved or paid them. Your doctor can also request an appeal for you.

Grievance

A grievance is a complaint that does not involve a coverage determination. For example, grievances may be filed if you are unhappy with the quality of care or service you receive from us or from our SWHP network providers. You also have the right to file a grievance if you have any type of problem with us or one of our network pharmacies that does not involve coverage for a prescription drug.

We encourage your input and will not discriminate against you, refuse coverage, or engage in any other retaliation if you choose to file a complaint or request an appeal of a decision.

Additionally, we’re prohibited from retaliating against a physician or provider who has filed a complaint against us on your behalf. You may also refer to your Evidence of Coverage for complaint examples and complete details.

For status or process questions, or to obtain an aggregate number of grievances and appeals, please call Customer Service at 1-866-334-3141 (TTY 711), 8 a.m. – 8 p.m., 7 days a week; or write:

Scott and White Health Plan 1206 West Campus Drive Temple, TX 76502 Fax: 1-254-298-3086

You can also submit an appeal and grievance to Medicare:

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