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Appeals and Grievances

Appointing a Representative for an Appeal

This form is used when a beneficiary chooses to appoint a representative to appeal claims or authorizations on his or her behalf.

  • Created: Aug 16, 2018
  • Modified: Dec 29, 2017
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Grievance Form

Use this form to send in a written complaint or concern about issues that cannot be appealed, such as access to care or quality of care. The grievance may be against any member of your health care team, including your TRICARE doctor, Health Net Federal Services, LLC (HNFS) or a HNFS subcontractor.

Note: Disputing a Point of Service charge should not be submitted as a grievance. Please visit our Disputing Point of Service Charges page to learn more.

  • Created: Apr 29, 2021
  • Modified: Apr 29, 2021
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