Grievances should be submitted to our Customer Service Department. Within 5 days the member will receive an acknowledgment letter and detailed description of the grievance process. The OATH is committed to providing every member the right to high quality care and services. Sometimes, despite our best efforts, members are not happy with the care or service they receive. You may be dissatisfied with a doctor, a facility or support services, or you may have concerns about how decisions regarding your health care are made.
Every member has the right to a formal appeal process.
This is the process that The OATH has developed and requires you to use in order to pursue any dispute regarding your benefit plan or the care you receive. You can file an appeal either verbally or in writing. If you choose to call The OATH, an Appeals and Grievance Coordinator will assist you in completing the appeals request form. All written appeals must include the member s name and important information related to the appeal, including the date of service, provider s name, date of denial, date service was requested and any relevant medical records. Medical Necessity appeals may be requested from decisions denying pre-authorization, denying claims payment or determining medical necessity.