A grievance is a formal complaint. Filing a grievance with Medica means that you would like us to address your complaint. This is not part of the appeals process; but you can submit a grievance along with an appeal and it will not affect the outcome of the appeal.
If you would like to designate someone other than the member to serve as authorized representative, please fill out this section.
In order to act as an authorized representation, the member will need to fill out the Appointment of Representative form. You can download and complete this form, then attach it below. You also have the option to fax or mail the form, if you prefer.
Last Updated December 2022