MEMBER HANDBOOK - Community Care Behavioral Health
MEMBER HANDBOOK - Community Care Behavioral Health
MEMBER HANDBOOK - Community Care Behavioral Health
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37<br />
What is a Grievance?<br />
A grievance is what you file when you do not<br />
agree with <strong>Community</strong> <strong>Care</strong>’s decision that a<br />
service that you or your provider asked for is<br />
not medically necessary. A grievance is usually<br />
about concerns you have, or your provider has,<br />
about getting treatment approved. You may file<br />
a grievance in writing or by phone. You can file<br />
a grievance if <strong>Community</strong> <strong>Care</strong> does any one of<br />
these things:<br />
• Denies a covered service.<br />
You can file a<br />
grievance when<br />
you do not agree<br />
with <strong>Community</strong><br />
<strong>Care</strong>'s decision<br />
that a service<br />
that you or your<br />
provider asked for<br />
is not medically<br />
necessary.<br />
• Approves less than what was asked for.<br />
• Approves a different service from the one that was asked for.<br />
What should I do if I have a Grievance?<br />
First Level Grievance<br />
If <strong>Community</strong> <strong>Care</strong> does not completely approve a service for you, we<br />
will tell you in a letter. The letter will tell you how to file a grievance. You<br />
have 45 days from the date you receive this letter to file a grievance.<br />
To file a grievance, you can either:<br />
• Call <strong>Community</strong> <strong>Care</strong> and tell us your grievance.<br />
• Write down your grievance and send it to us at:<br />
<strong>Community</strong> <strong>Care</strong> <strong>Behavioral</strong> <strong>Health</strong> Organization<br />
One Chatham Center, Suite 700<br />
112 Washington Place<br />
Pittsburgh, PA 15219<br />
Attention: Complaints and Grievances Department<br />
Your provider can file a grievance for you if you give the<br />
provider your consent in writing to do so.<br />
If your<br />
provider files<br />
a grievance<br />
for you, you<br />
cannot file<br />
a separate<br />
grievance on<br />
your own.<br />
Customer Services 1-800-553-7499