If you feel that you are being encouraged to leave (disenroll from) the plan.

Issues with the service you receive from Customer Service.

Some types of problems that can lead to filing a grievance include: Grievances don't involve problems related to approving or paying for Medicare Part D drugs. You need to file the grievance (complaint) within 60 calendar days of the item you want to complain about-whether by phone or writing to UnitedHealthcare.įiling a grievance isn't the same as a request for a coverage decision.

This includes problems related to quality of care, waiting times, and the service you receive. The complaint process is only used for certain types of problems.

You must include this signed statement with your grievance.When will UnitedHealthcare give you an answer?Ī grievance is a complaint.(Note: You may appoint a physician or a Provider.) For example: “I appoint to act as my representative in requesting a grievance from your Medicare Advantage health plan regarding the denial or discontinuation of medical services.” Provide your Medicare Advantage health plan with your name, your Medicare number and a statement which appoints an individual as your representative.You may appoint an individual to act as your representative to file the grievance for you by following the steps below: Someone else may file the grievance for you on your behalf.For Part B drugs, your Medicare Advantage plan will provide a decision as fast as possible, but no later than 24 hours in Time-Sensitive situations with no allowable extensions.Ī grievance may be filed by any of the following: If your Medicare Advantage health plan or your Primary Care Provider decides, based on medical criteria that your situation is Time-Sensitive or if any physician calls or writes in support of your request for an expedited review, your Medicare Advantage health plan will issue a decision as fast as possible, but no later than seventy-two (72) hours-plus 14 calendar days, if an extension is taken-after receiving the request. your ability to regain maximum function.A Time-Sensitive situation is a situation where waiting for a decision to be made within the timeframe of the standard decision-making process could seriously jeopardize: You have the right to request and receive expedited decisions affecting your medical treatment in 'Time-Sensitive' situations. Complaints and appeals may be filed over the phone or in writing. There is also a complaint process if you are not satisfied with the quality of services that you received from United Behavioral Health or your behavioral health practitioner. United Behavioral Health offers an appeal process if you are not satisfied with a care advocacy or claims payment decision related to behavioral health services. You must include this signed statement with your appeal.Your representative must also sign and date this statement.Provide your Medicare Beneficiary Indentifier (MBI) from your member ID card.Provide your name, address and phone number and that of your representative, if applicable.(Note: You may appoint a physician or a Provider.) For example: “I appoint to act as my representative in requesting an appeal from your Medicare Advantage health plan regarding the denial or discontinuation of medical services.” Fill out the Appointment of Representative Form (PDF) and mail it to your Medicare Advantage plan or.

You may appoint an individual to act as your representative to file the appeal for you by following the steps below: Someone else may file the appeal for you on your behalf.An appeal may be filed by any of the following:

Uhc timely filing limit