Central Health Medicare Plan members have the right to offer ideas, ask questions,
voice complaints and submit appeals. Our goal is to listen, resolve member problems,
and improve our service to our members.
What are appeals and grievances?
You have the right to make a complaint if you have concerns or problems related
to your coverage or care. "Appeals" and "grievances" are the two different
types of complaints you can make.
An "appeal" is the type of complaint you make when you want us to reconsider and
change a decision we have made about what services or benefits are covered for you
or what we will pay for a service or benefit. For example, if we refuse to cover
or pay for services you think we should cover, you can file an appeal. If Central
Health Medicare Plan or one of our plan providers refuses to give you a service
you think should be covered, you can file an appeal. If Central Health Medicare
Plan or one of our plan providers reduces or cuts back on services or benefits you
have been receiving, you can file an appeal. If you think we are stopping your coverage
of a service or benefit too soon, you can file an appeal.
A "grievance" is the type of complaint you make if you have any other type of problem
with Central Health Medicare Plan or one of our plan providers. For example, you
would file a grievance if you have a problem with things such as the quality of
your care, waiting times for appointments or in the waiting room, the way your doctors
or others behave, being able to reach someone by phone or get the information you
need, or the cleanliness or condition of the doctor’s office.
Additional Information is available on
Drug Coverage determination, grievances, and appeals.
Please contact Member Services
if you would like information on the aggregate number of grievances, appeals, and
exceptions received by Central Health Medicare Plan.