Iowa Medicaid MCO Complaint Survey
Page 1 of 1
1.
Which MCO would you like to file a complaint? Check all that apply.
Iowa Total Care
AmeriGroup Iowa (PBM: Express Scripts)
Molina Healthcare
2.
How would you categorize this issue?
Payment/Reimbursement
Preferred Drug List (PDL)
Durable Medical Equipment (DME)
Specialty Pharmacy
General Concern
Other, please specify
3.
In this open field, please describe your concern or complaint?
4.
Have you consulted the MCO or IME with this issue?
-- None --
Yes
No
5.
If so, what was their response?
6.
First Name/Last Name
7.
Daytime Phone
8.
Cell Phone
9.
Email Address
10.
Practice Site
11.
Pharmacy NPI (optional)
