PHC Florida

Robert Heglar
AHF Provider

Filing a Complaint or Grievance

If you are unhappy with PHC Florida for any reason, you can file a complaint or grievance.  You can file a complaint or grievance any time up to one (1) year from the date of what happened to make you unhappy.  You can’t be disenrolled or penalized if you file a complaint.

You can file a complaint or grievance by contacting Member Services.  If you file a complaint and we can’t resolve it by the end of the following business day, your complaint will become a grievance.  It will be moved to our grievance system.

You can also file a grievance in writing.  Explain in detail what happened to make you unhappy.  Tell us the names and titles of the people involved, and the date, time and location of the incident.  Include your name, PHC Florida ID number found on your ID card, current address, and phone number.  Send your grievance to Member Services.  You can also fax it to us.

Your doctor can file a grievance for you if you give him or her written approval.

We will send you a letter telling you we got your grievance.  We’ll send the letter within five (5) business days from the day we got it.  We must resolve your grievance within 90 calendar days from the day we got it.  We will send you a letter that tells what we did to address your concerns.  This timeframe can be extended up to 14 calendar days if you ask for it.  You can use the extra time if you want to give us more information about your grievance.  The timeframe may also be extended up to 14 calendar days if we find there is a need for more information.  We will do this if a delay is in your interest.  We will send you a letter within five (5) business days to tell you if we extend the deadline.

Call Member Services if you have questions or need help filing your grievance.  You can also call Member Services if you have more information to add about your grievance after you filed it.

For more detail about the complaints process, look in the Enrollee Handbook.  See Chapter 11.


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AHCA 062614 PHC MMA Form 17.0