Grievances, Appeals, and State Fair Hearings

Submitting a Grievance

If you are unhappy about things like the benefit plan, a dentist, or the way MCNA does things you can file a grievance.

If you need help with a problem, we want to help. If you have a grievance, please contact our Member Hotline to tell us about your problem. An MCNA Member Hotline Representative can help you file a grievance. Most of the time we can help you right away or within a few days at the most. You can also file a grievance by completing our Grievance Form.

You can find more information about the grievance process in your Member Handbook.

Submitting an Appeal

If you are not happy with MCNA's decision to deny or limit services requested by your dentist, you can contact our Member Hotline and file an appeal within 60 calendar days from the date the decision is mailed. You or your dentist can send us more information to show why you do not agree with our decision. You can also file an appeal by completing our Appeal Form.

You can find more information about the appeal process in your Member Handbook.

Requesting a State Fair Hearing with IDHW

You can request a State Fair Hearing if you are not satisfied after MCNA's appeal process. You will need to file a grievance with MCNA and receive a determination prior to requesting a State Fair Hearing.

You have the right to request a fair hearing with the Idaho Department of Health and Welfare (IDHW) if you are not satisfied with the resolution of your appeal. You have 120 calendar days from the date the decision was mailed to file your request for a fair hearing. You must explain why you disagree with this decision and include any other information you want the IDHW to know. Your request must be received by the IDHW or postmarked within 120 calendar days from the date the decision was mailed.

To request a State Fair Hearing, notify the IDHW in writing or complete a Fair Hearing Request form. Fair Hearing Request forms are available at any IDHW local office or via e-mail at: MyBenefits@dhw.idaho.gov. Include a copy of this notice with your request. To notify IDHW of your request, you may do any of the following:

If you ask for a State Fair Hearing, you will get a packet of information letting you know the date, time, and location of the hearing. Most State Fair Hearings are held by telephone. At that time, you or your representative can tell why you need the service that MCNA denied.

An Idaho Department of Health and Welfare (IDHW) office can give you information about the Idaho Administrative Procedures Act (IDAPA) Rules Governing Contested Case Proceedings and Declaratory Rulings. To learn more, call a local IDHW office. You can also access these rules online on the Idaho Office of Administrative Rules Coordinator website that lists the current administrative rules for IDHW.

You can find more information about the State Fair Hearing process in your Member Handbook.