MEMBER HANDBOOK - Community Care Behavioral Health

37
What is a Grievance?
A grievance is what you file when you do not
agree with Community Care’s decision that a
service that you or your provider asked for is not
medically necessary. A grievance is usually about
your or your provider's concerns about getting
treatment approved. You may file a grievance in
writing or by phone. You can file a grievance if
Community Care does any one of these things:
• Denies a covered service.
• Approves less than what was asked for.
You can file a
grievance when
you do not agree
with Community
Care's decision
that a service
that you or your
provider asked for
is not medically
necessary.
• Approves a different service from the one that was asked for.
What should I do if I have a Grievance?
First Level Grievance
If Community Care does not completely approve a service for you, we
will tell you in a letter. The letter will tell you how to file a grievance. You
have 45 days from the date you receive this letter to file a grievance.
To file a grievance, you can either:
• Call Community Care and tell us your grievance.
• Write down your grievance and send it to us at:
Community Care Behavioral Health Organization
1 East Uwchlan Avenue, Suite 311
Exton, PA 19341
Attention: Complaints and Grievances
Your provider can file a grievance for you if you give the provider
your consent in writing to do so.
If your
provider files
a grievance
for you, you
cannot file
a separate
grievance on
your own.
Customer Services 1-866-622-4228