Complaints and Appeals
Sunshine Health wants to fully solve your problems or concerns. A grievance is an expression of dissatisfaction about any matter other than an “action.” An appeal is a request to review a Notice of Action. For more information on the Complaints, Grievances and Appeals Process please refer to the Member Handbook.
Filing an Appeal
An appeal is a request to review a Notice of Action. This review makes us look again at the Notice of Action. You can request this review by phone or in writing.
A notice of action is sent when Sunshine Health:
- Denies the care requested.
- Decreases the amount of care.
- Ends care that has previously been approved.
- Denies payment for care and you may have to pay for it
You will know that Sunshine Health is taking an action because we send you a letter. The letter is called a Notice of Action. If you do not agree with the action, you may request an appeal.
Filing a Grievance
We hope our members will always be happy with Sunshine Health, as well as our provider network. If you are not happy, please let us know. This includes if you do not agree with a decision we have made about paying for your care. A grievance is an expression of dissatisfaction about any matter other than a Notice of Adverse Action. You have the right to file a grievance. You will not be treated differently because you have filed a grievance. Your benefits will not be affected.
A grievance may be filed by calling Sunshine Health or by sending us a letter within one year of the event. We can be reached at:
Grievance and Appeal Coordinator
1301 International Parkway
Sunrise, FL 33323
1-866-796-0530 (TDD/TTY 1-800-955-8770)
Hours: 8 a.m. to 8 p.m. Monday through Friday
Be sure to include:
- Your first and last name.
- Your Medicaid ID number.
- Your address and telephone number.
- What you are unhappy with.
- What you would like to have happen.
Or you may fax the letter to 1-866-534-5972.