MODEL MEMBER HANDBOOK COMPLAINT AND APPEAL LANGUAGE Elderwood Health Plan will try its best to deal with your concerns or issues as quickly as possible and to your satisfaction. You may use either our complaint process or our appeal process, depending on what kind of problem you have. There will be no change in your services or the way you are treated by Elderwood Health Plan staff or a health care provider because you file a complaint or an appeal. We will maintain your privacy. We will give you any help you may need to file a complaint or appeal. This includes providing you with interpreter services or help if you have vision and/or hearing problems. You may choose someone (like a relative or friend or a provider) to act for you. To file a complaint or to appeal a plan action, please call: or to: 1-866-843-7526 Elderwood Health Plan Attn: Complaint and Appeals, 500 Seneca Street, Buffalo, NY 14204. When you contact us, you will need to give us your name, address, telephone number and the details of the problem. What is a Complaint? A complaint is any communication by you to us of dissatisfaction about the care and treatment you receive from our staff or providers of covered services. For example, if someone was rude to you or you do not like the quality of care or services you have received from us, you can file a complaint with us. The Complaint Process You may file a complaint orally or in writing with us. The person who receives your complaint will record it, and appropriate plan staff will oversee the review of the complaint. We will send you a letter telling you that we received your complaint and a description of our review process. We will review your complaint and give you a written answer within one of two timeframes. If a would significantly increase the risk to your health, we will decide within 48 hours after receipt of necessary information but the process will be completed within 7 days of receipt of the complaint. For all types of complaints, we will notify you of our decision within 45 days of receipt of necessary information, but the process must be completed within 60 days of the receipt of the complaint. Our answer will describe what we found when we reviewed your complaint and our decision about your complaint. How do I Appeal a Complaint Decision?
MODEL MEMBER HANDBOOK COMPLAINT AND APPEAL LANGUAGE Elderwood Health Plan will try its best to deal with your concerns or issues as quickly as possible and to your satisfaction. You may use either our complaint process or our appeal process, depending on what kind of problem you have. There will be no change in your services or the way you are treated by Elderwood Health Plan staff or a health care provider because you file a complaint or an appeal. We will maintain your privacy. We will give you any help you may need to file a complaint or appeal. This includes providing you with interpreter services or help if you have vision and/or hearing problems. You may choose someone (like a relative or friend or a provider) to act for you. To file a complaint or to appeal a plan action, please call: 1-866-843-7526 or to: Elderwood Health Plan Attn: Complaint and Appeals, 500 Seneca Street, Buffalo, NY 14204. When you contact us, you will need to give us your name, address, telephone number and the details of the problem. What is a Complaint? A complaint is any communication by you to us of dissatisfaction about the care and treatment you receive from our staff or providers of covered services. For example, if someone was rude to you or you do not like the quality of care or services you have received from us, you can file a complaint with us. The Complaint Process You may file a complaint orally or in writing with us. The person who receives your complaint will record it, and appropriate plan staff will oversee the review of the complaint. We will send you a letter telling you that we received your complaint and a description of our review process. We will review your complaint and give you a written answer within one of two timeframes. If a would significantly increase the risk to your health, we will decide within 48 hours after receipt of necessary information but the process will be completed within 7 days of receipt of the complaint. For all types of complaints, we will notify you of our decision within 45 days of receipt of necessary information, but the process must be completed within 60 days of the receipt of the complaint. Our answer will describe what we found when we reviewed your complaint and our decision about your complaint. How do I Appeal a Complaint Decision?
EHP-Model-Handbook-Complaint-and-Appeal-2018.docx