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Grievance or Complaint

This form is for 2023 requests only.
To submit a grievance or complaint for 2024, you can do so through your member website.

Please complete the fields below to submit an online request for a medical or prescription drug grievance or complaint. Fields marked with an asterisk (*) are required.

If you need assistance submitting this form, call provider services at 504-849-4688 or 877-346-5703.


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