Grievance Form

If you are unhappy with anything about your care or with Care1st Health Plan, we want to know about it. We also want to hear your suggestions about how we can improve our services. Please fill out the grievance form below, Care1st Health Plan will work with you to resolve your grievance to your satisfaction. Grievance resolution will be mailed to you within 30 days.

Member Information

Please fill out all of the following fields that contain important member information.


Grievance Information

This information becomes part of the permanent record.

  1. Describe what happened -- list the names involved, including the provider.
  2. Have the Member / Guardian discussed the problem with the provider or any other person? If so, what were the results?