MEMBER HANDBOOK - Community Care Behavioral Health
MEMBER HANDBOOK - Community Care Behavioral Health
MEMBER HANDBOOK - Community Care Behavioral Health
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36<br />
You must send your request for an External Complaint Review in<br />
writing to either:<br />
• Pennsylvania Department of <strong>Health</strong> Bureau of Managed <strong>Care</strong><br />
Room 912 <strong>Health</strong> & Welfare Building, 625 Forster Street<br />
Harrisburg, PA 17120<br />
Phone: 1-888-466-2787; Fax: 1-717-705-0947<br />
Relay Service: 1-800-654-5984 (For persons with hearing impairments)<br />
-or-<br />
• Pennsylvania Insurance Department Bureau of Consumer Services<br />
1321 Strawberry Square, Harrisburg, PA 17120<br />
Phone: 1-877-881-6388<br />
If you send your request to the wrong department, it will be sent to the<br />
correct department. The Pennsylvania Department of <strong>Health</strong> or the<br />
Pennsylvania Insurance Department will get your complaint information<br />
from <strong>Community</strong> <strong>Care</strong>. You may also send them any other information<br />
that may help with the External Review of your complaint. You may<br />
be represented by an attorney or another person during the External<br />
Complaint Review. A decision letter will be sent to you after the<br />
decision is made. This letter will tell you the reason(s) for the decision<br />
and what you can do if you don’t agree with the decision.<br />
What should I do to continue getting services if <strong>Community</strong><br />
<strong>Care</strong> was authorizing services, but decided that those services<br />
should now be reduced, changed, or stopped because they<br />
are not covered services for me?<br />
If you file:<br />
A First Level Complaint within 10 days of the date on the<br />
letter from <strong>Community</strong> <strong>Care</strong> telling you of this decision...<br />
A Second Level Complaint within 10 days of the date on the<br />
letter from <strong>Community</strong> <strong>Care</strong> telling you of this decision...<br />
An External Complaint within 10 days of the date on the<br />
letter from <strong>Community</strong> <strong>Care</strong> telling you of this decision...<br />
You will<br />
continue<br />
to receive<br />
those<br />
services until<br />
a decision<br />
is made<br />
about your<br />
complaint.<br />
Customer Services 1-800-553-7499