Forms
Complaints, Grievance and Appeals Form
You can file your Complaint, Grievance or Appeal by completing the Complaints, Grievance and Appeals Form. Please be sure to complete all form fields. Once all is done you can deliver it visiting our Service Offices, or you can send it by fax at (787) 300-3931 and (787) 300-3932, by email at querellas-beneficiarios@fmsaludpr.com or by mail at:
First Medical Health Plan, Inc.
Grievance and Appeals Department – FM Vital
PO Box 195079
San Juan, PR 00919-5079
If you need a copy of the Complaints, Grievance and Appeals Form, please feel free to contact First Medical Customer Service at 1-844-347-7800; TTY/TDD users should call 1-844-347-7805, Monday through Friday from 7:00 a.m. to 7:00 p.m. First Medical will send you free of charge, the Complaints, Grievance and Appeals Form in five (5) business days from the date of your request.
Request for the Appeal File Copy
You can request a copy of your appeal file by completing the Request for the Appeal File Copy. Please be sure to complete all form fields. Once all is done you can deliver it visiting our Service Offices, or you can send it by fax at (787) 300-3931 and (787) 300-3932, by email at querellas-beneficiarios@fmsaludpr.com or by mail at:
First Medical Health Plan, Inc.
Grievance and Appeals Department – FM Vital
PO Box 195079
San Juan, PR 00919-5079
If you need a copy of the Request for the Appeal File Copy, please feel free to contact First Medical Customer Service at 1-844-347-7800; TTY/TDD users should call 1-844-347-7805, Monday through Friday from 7:00 a.m. to 7:00 p.m. First Medical will send you free of charge, the Request for the Appeal File Copy in five (5) business days from the date of your request.