Member Complaint/Concern Form

As a member of Exclusive Care Health Plan, you have the right to file a complaint/concern against Exclusive Care Health Plan or its providers without fear of negative action by Exclusive Care Health Plan, your Doctor, or any other provider. If you do have a complaint/concern please complete the below form and return it by mail, email, or fax. Once received, you will receive an acknowledgement letter within 5 days of receipt of the completed form. A notice will be sent to you within 20 days of any final action taken by Exclusive Care, when appropriate.

 

Member Complaint/Concern Form