Grievance

Grievance Form

Please hit Blue Save button to submit the case and hit Red Cross Button to cancel the case.

Allure Speciality Pharmacy accepts complaints that are in writing through this webpage and contains the complainants' contact information which may be shared with accredited organizations unless the complainant desires to remain anonymous. To file a grievance against a URAC-accredited organization, please fill out the form below. Required fields are marked with an asterisk (*).

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PLEASE DO NOT submit any personally protected health information (PHI), such as social security number, date of birth, diagnosis, etc., on this website. Protected health information (PHI) is any information about health status, provision of health care, or payment for health care that can be linked to a specific individual. Submitting PHI to Allure Specialty pharmacy is strictly prohibited. Should Allure Specialty pharmacy receive PHI, it will not be accepted and you will be contacted with a request to re-submit your complaint with PHI removed. Additional information about what is PHI can be found here: http://www.hhs.gov/answers/hipaa/what-is-phi/index.html



Prior to filing a grievance with Allure Specialty pharmacy, we strongly recommend that you contact the individual organization to file your complaint and allow the organization an opportunity to resolve the matter.

Allure Specialty pharmacy may contact you to clarify the facts surrounding your grievance but is not obliged to do so.

Allure Specialty pharmacy has no authority to resolve disputes between any complainant and a Allure Specialty pharmacy-accredited organization based on a benefit determination or the payment of such benefits.

Allure Specialty pharmacy will not disclose or share information regarding any specific outcome of a grievance or complaint investigation, however may collect statistical data for tracking purposes.

By submitting this complaint, you authorize Allure Specialty pharmacy to begin the investigation including sharing your contact information unless you have elected to remain anonymous. Allure Specialty pharmacy and/or the accredited organization may need to contact you directly for additional information to facilitate the investigation as is deemed necessary. You agree that you will not hold Allure Specialty pharmacy liable for any disclosure of information contained in your complaint.

Allure Specialty pharmacy can only investigate a Allure Specialty pharmacy accredited organization for an issue that is related to Allure Specialty pharmacy’s program for which the organization is accredited. If you have a complaint that is not in scope with the accreditation, you may have other recourse for filing a complaint with your state insurance or health agency (see http://www.naic.org/state_contacts/sid_websites.htm) (National Association of Insurance Commissioners). Allure Specialty pharmacy cannot advise you on your alternative recourse if Allure Specialty pharmacy cannot evaluate your grievance.

I have read and agree to the information, terms and conditions as indicated on this website. I further understand that Allure Specialty pharmacy expressly prohibits the submission of protected health information and reserves the right to change terms and conditions without further notice and/or as required by law. Checking this box indicates my agreement to these terms and conditions and I understand it is required for submission of complaints. If you do not agree, your grievance will not be submitted.

Check below if you agree and want to submit your grievance.


Agree