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Filing a Grievance

What is a Grievance and who can file one?

The grievance process allows you, or your authorized representative (PDF) (family member, etc.) acting on your behalf, to file a grievance either orally or in writing. A provider may not file a grievance on your behalf. A grievance is defined as any member expression of dissatisfaction about any matter other than an “adverse action” including but not limited to complaints about providers, provider staff, quality of provider office site, provider/plan administrative processes and health plan staff. Coordinated Care staff are available to assist you in completing forms or other procedural steps to file a grievance.

What happens after I file a Grievance?

Coordinated Care will acknowledge receipt of each grievance either orally or in writing within 2 calendar days (48 hours) of receipt. Grievance investigation, resolution and notice to you will occur as expeditiously as your health condition requires, not exceeding 45 calendar days from the date of the initial receipt of the grievance.