Grievances and Appeals

If you are dissatisfied with any aspect of the operations, activities, or behavior of the health plan staff or providers you have the right to file a grievance. 

If you have received a benefit determination that is not in your favor, you have the right to file for an appeal of that determination.

Grievances and appeals may be filed in writing, by phone, mail, email, or fax.  You have the right to file the grievance or appeal yourself, or you may ask a representative or your provider to do it on your behalf.  If you need assistance in filing a grievance or appeal, we can help you.  If you need help, please:

WSCC recently became aware of a transposed number to our Member Grievance and Appeals fax number.  We have since fixed the error.  Our new fax number to the Member Grievance and Appeals fax line is:   1-844-235-6050.

If  you used the erroneous fax number recently, WSCC requests you contact Member Services at 1-844-543-8996, for further assistance. 

• Call Member Services. The phone number is 1-844-543-8996 (TTY: 711).
• Send it electronically by fax. The fax number is 1-844-235-6050.
• NMQI@WesternSkyCommunityCare.com
• Send a letter by mail. The address is:

Western Sky Community Care

ATTN: Appeals

5300 Homestead Road NE

Albuquerque, NM 87110

We can provide translation or interpreter service if you need it.

You can find detailed information about grievances and appeals in our Member Handbook.