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Submit a Concern

For Care Coordinators Who Are Employed by or Delegates of Medica

Please share any concerns about experiences working with healthcare providers, service providers or vendors.

This form must not be used for reporting a member grievance to Medica. If a Medica member has a grievance, refer them to Medica Customer Service at the number on the back of their Medica ID card to file a grievance.

Medica Member Details

Care Coordinator Information

Entity Information

All fields in this section are OPTIONAL

Details of Concern

Provide clear details about your concern and its impact on the member. Include names of the people of involved when possible and describe actions that have already been taken.