If you have an issue with your EBCI Tribal Option Plan, you can file a grievance.

We hope your Tribal Option Plan serves you well. If, however, you are unhappy with some aspect or have a complaint, you may talk with your Primary Care Provider, your Care Manager, or call Member Services at 800.260.9992. You may also write to:

EBCI Tribal Option
241 Hospital Loop
Cherokee, NC 28719

For Medicaid members, a grievance and a complaint are the same thing.

Contacting us with a grievance means that you are unhappy with Tribal Option, your provider, or your health services. Most problems like this can be solved right away. Whether your issue is quickly resolved or we need to do some work on your behalf, we will record your call, your problem, and our solution. We will inform you that we have received your grievance in writing. We’ll also send you a written notice when we have finished working on your grievance.

You can ask a family member, a friend, or a legal representative to help you with your complaint. If you need our help because of a hearing or vision impairment; assistance with our translation services; or guidance on filing out any forms, please let us know. We’re happy to help.

You can contact us by phone:
Call Member Services at 800.260.9992, Monday through Friday, from 8 a.m. to 4:30 p.m.

You can write us regarding your complaint:
Send your note to EBCI Tribal Option, 241 Cherokee Hospital Loop, Cherokee, NC 28719.

Once we receive your issue or grievance, we’ll begin resolving it immediately:

  • We will let you know in writing that we received your grievance.
  • We will review your complaint and tell you how we have resolved it, in writing, within twenty-one (21) business days from receiving your complaint or grievance.
  • EBCI Tribal Option may extend the time frame for resolving your grievance up to fourteen (14) calendar days if there is a need for additional information and the delay is in your best interest.
  • If we extend the time frame, we will make every effort to give you a prompt verbal notice of the delay and give you written notice within two (2) calendar days. The notice will include the reason for the decision to extend the time frame. We will give you the right to file a grievance if you disagree with that decision.

These issues will be handled according to our Grievance Procedures. You can find them by clicking here.

Determining your IHS eligibility.

Before participating in EBCI Tribal Option, you must determine your Indian Health Services (IHS) eligibility. If your IHS eligibility is denied and you feel that you are entitled to these services, you can appeal by contacting the CIHA Patient Registration Manager at 828.497.9163. This appeal will be processed by the CIHA Eligibility Committee and a decision rendered within thirty (30) days of filing the appeal.

How to properly dispute a decision you don’t agree with.

Medicaid and NC Health Choice members have a right to appeal decisions regarding the application of their Medicaid benefits. When members do not agree with Medicaid’s decisions on an appeal, they can ask the state Medicaid agency for a State Fair Hearing.

Medicaid must issue a letter of denial, reduction, termination of service, or eligibility determination. It is important for you to read the letter or seek assistance in understanding the direction and guidance issues in the letter. If you need assistance, contact Member Services at 800.260.9992, the Medicaid Appeals Line at 919.855.4350, or the NC Medicaid Ombudsman at 877.201.3750. Your letter will explain your right to appeal Medicaid’s decision.

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Medicaid Expansion will Launch on Dec. 1,2023
With the passage of the budget, Medicaid Expansion is launching December 1st, 2023. More information about Medicaid Expansion can be found here.