Initial Organizational Determinations, Appeals & Grievances

Click here to read our policies and procedures concerning coverage determinations, exceptions, appeals and grievances.

Click here for the form to appoint a represenative to act on your behalf.

Click here for the form to request a coverage determination. You may use the form to ensure you provide the information necessary to process your request.

You may print, complete and mail the forms to the address located on the ESSENCE Customer Service page.

To obtain information about the aggregate number of grievances, appeals and exceptions filed with ESSENCE, contact us.