Grievance Process

Your health and satisfaction matter to us. If you have a problem or concern with your health care, please contact us. We will work with you to try to find a solution to your problem.

You have rights as a member of our Plan  We pledge to honor your rights, to take your problems and concerns seriously, and to treat you with respect.

Sometimes you might need a formal process to deal with a problem you are having as a member of our Plan. There are two kinds of grievances you can request.

Standard Grievance

You or your appointed representative may submit a standard grievance if you have a problem that is not related to a coverage decision or “Organization Determination.” We will give you a decision within 30 days after you ask for it. We may extend the timeframe by up to 14 days if you request the extension, or if we can make a case for needing more information, and the delay is in your best interest.

Expedited (Fast) Grievance

You, any doctor, or your appointed representative can ask for an expedited grievance if you disagree with Alliance CompleteCare’s decision not to give you an expedited decision on a medical care issue. Or you can ask for an expedited grievance if you disagree with our decision to extend time on an initial decision or appeal. We will give you our decision within 24 hours after you or your doctor ask for it.

If you are concerned about the quality of care you receive, you can send your complaint to Alliance CompleteCare, or to the Quality of Improvement Organization (QIO), an independent review organization, or both. The QIO for Alliance CompleteCare is:

Health Services Advisory Group, Inc.
Attn: Beneficiary Protection
5201 W. Kennedy Boulevard, Suite 900
Tampa, Florida 33609-1822

 

H7292_6f CMS Approved 03072013

Last updated 03072013