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 30 calendar days. If you or your dentist think waiting could affect your health, life or safety, you may request a fast (expedited) review.

If a Liberty dentist find a fast review is needed, we will give you an answer within 72 hours. If a Liberty dentist determines that a fast review is not needed, we will process your request within 30 calendar days.

Appeals vs. state fair hearings (Medicaid only)

The State Fair Hearing process applies only to Medicaid members. It applies only to appeals, not grievances. If you have Medicaid dental coverage through Liberty Dental Plan and you file an appeal, you must first complete our internal appeal process before you can ask for a State Fair Hearing. Using Liberty's internal appeals process does not take away your right to a State Fair Hearing. After we finish your appeal and the decision is not in your favor, or if we do not finish your case on time, you can ask your state's Medicaid office for a State Fair Hearing letter.