A grievance involves a complaint of unfair treatment or quality of care received from a provider’s staff. A complaint involves a communication from the Covered Person expressing discontent or dissatisfaction with services. You can file a complaint in writing or by phone at:

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University of Utah Health Plans

Appeals Committee Chairperson, Attn: MHC, 6053 Fashion Square Dr.,

Suite 110, Murray, UT 84107

Telephone: 1-844-262-1560

You may also file a grievance or complaint online at:

https://app.healthcare.utah.edu/uhealthPlans/forms/montanaHealth_complaint

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For more information on grievances or complaints see Section 10 – Complaints, Grievances and Appeals of your policy document at: https://www.mountainhealth.coop/individual-plan-documents-wy

Grievance or Complaint

A Claimant (or someone acting on the Claimant’s behalf) may request an independent external review of an adverse benefit determination within 120 days after notice of an adverse benefit determination.  In most cases, before filing an external review, you must first exhaust your internal grievance and appeal rights.

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The request shall be made in duplicate and include a fee of fifteen dollars ($15.00) payable by check or money order payable to: The Office of the Wyoming State Treasurer.

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• The fee may be waived for a member whose income is at or below the current federal poverty level guidelines and who files a financial hardship application available upon request from the Wyoming Insurance Department. Request for external review must be made in writing or orally to the University of Utah Health Plans at:

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University of Utah Health Plans

Appeals Committee Chairperson, Attn: MHC

6053 Fashion Square Dr.

Suite 110, Murray, UT 84107

Telephone: 1-844-262-1560

For more information on external reviews see Section 10 – Complaints, Grievances and Appeals of your policy document at: https://www.mountainhealth.coop/individual-plan-documents-wy