File a grievance or appeal

How to file a grievance or appeal

To submit a written grievance or appeal to Liberty Dental Plan, complete the form at the bottom of this page. You can also download the form and send it to us.

You don’t have to use any specific form to file a grievance or appeal. We accept grievances and appeals through any method that works best for you, including mail, email, fax, or phone.

If you need help with the form or if you have questions, please contact us.

What happens when you file a grievance or appeal 

Your grievance or appeal will be reviewed by Liberty shortly after we receive it.  

You will get a letter from us letting you know we received your request. If you would like to add anything to your case, please contact us as soon as possible.

We will review your grievance or appeal and send you a written decision within the required timeframes. If you or your dentist think waiting could affect your health, life or safety, you may request a fast review.

If Liberty finds a fast review is needed, we will give you an answer as fast as your health needs it but no later than the required timeframe. If Liberty determines that a fast review is not needed, we will review your case and give you an answer within the standard timeframes from when we received your original request.

Appeals vs. state fair hearings (Medicaid only)

If you have Medicaid dental coverage through Liberty, you must first complete our internal appeal process before you can ask for a fair hearing from your state’s Medicaid office.

After you have completed Liberty’s internal appeal process, you can request a state fair hearing. You can request a fair hearing if you receive a decision that is not in your favor or if we do not finish your case on time.