• First Choice
• First Choice Miembro
• Provider
• Pharmacy

Grievances and Appeals

A grievance occurs when you are dissatisfied with a provider, the plan or a benefit. First Choice members may file a grievance at any time.

You may also appeal actions taken by First Choice at any time. Examples of actions that may be appealed include denial or limitation of service requests or denial of payment for a service.

If you have a grievance or if you wish to appeal a First Choice action, call Member Services or write us a letter. A representative will record your concerns and take the necessary actions. You will be notified in writing about the results of your grievance or appeal.

If you think there was an error in the outcome of your final appeal with First Choice, you have the right to request a State Fair Hearing by contacting the South Carolina Department of Health and Human Services, Division of Appeals and Hearings at 1.803.898.2600.

You have the right to a personal representative to assist and represent you during grievance and appeal processes. You also have the right to present supporting documentation.

For a detailed description of grievance and appeal procedures, call Member Services at 1.888.276.2020.