You will get a written response to your grievance as quickly as your case requires based on your health status, but no later than 30 calendar days after we get your complaint. You may file a grievance in writing by sending a letter telling us about your grievance: When we add to the deadline, we will immediately let you know the reason(s) for the delay in writing. We may add to the timeframe by up to 14 calendar days if you request the extension, or if we justify a need for more information and the delay is in your best interest. If your grievance involves the quality of the care you received, you will get a written response. Generally, you will be sent a written response to your grievance as quickly as your case requires based on your health status, but no later than 30 calendar days after we get it. If your concern is not resolved at the time of your first phone call, it will be sent on to a grievance coordinator to be resolved. We have made this process easy to follow so you will get a timely response. If Customer Service cannot resolve your concern over the phone, we have a formal process to review your complaints. We try to resolve any complaint you have over the phone. You must file a grievance with us no later than 60 days after the event or incident in question. You can also send us your grievance in writing to: If you have a grievance, we ask you to first call customer service at 1-87 TTY 711. Failure to provide required notices that comply with Centers for Medicare & Medicaid Services (CMS) standards.Failure by the plan sponsor to provide required notices.Failure to forward your case for an independent review if we don’t give you a decision within the required timeframe.Failure to give you a decision within the required timeframe.You believe our notices and other written materials are hard to understand.You disagree with our decision not to expedite your request for an expedited coverage determination or redetermination.Cleanliness or condition of pharmacy or medical office.Disrespectful or rude behavior by pharmacists or other medical staff.Problems with how long you wait on the phone or in the pharmacy or medical office. Problems with the customer service you receive.You feel that you’re being encouraged to leave (disenroll from) our plan.These issues may be reasons to file a grievance. You will get a written response to your Expedited Appeal as quickly as your case requires based on your health status, but no later than 72 hours after we receive your Expedited Appeal. You may file an Expedited Appeal over the phone by calling: You may file an Expedited Appeal in writing by sending a fax: You think that your covered services in a skilled nursing facility, home health or comprehensive outpatient rehabilitation facility is ending too soon.Coverage was denied and your health requires a quick response, or. When we add to the deadline, we will immediately let you know the reason(s) for the delay in writing.Įxpedited Appeals: You can ask for an expedited (fast) appeal if: You will get a written response to your appeal as quickly as your case requires based on your health status, but no later than 30 calendar days after we receive your appeal for medical service authorization or no later than 60 calendar days after we receive your appeal for payment. You may file an appeal in writing by sending a letter or fax:
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