If You Have a Complaint
If you are ever unhappy with the quality of service or care you receive from PHP (HMO SNP), you should make a complaint to us. We want you to be satisfied with the plan, our staff and our providers. By making a complaint, you bring the problem you experienced to our attention so we can take action. By making a complaint, you help us become a better health plan.
Below are examples of problems when you should make a complaint.
- You are not happy with the quality of your medical care, including care in the hospital.
- Someone did not respect your right to privacy or shared information about you that you feel should be confidential.
- You received poor customer service, experienced other negative behaviors or were disrespected by plan, provider or pharmacy staff.
- You had trouble getting an appointment or waited too long to get one.
- You waited too long on the phone to speak to your doctor, pharmacist or other provider, or plan staff.
- You waited too long at your doctor’s office, pharmacy or other provider’s facility to be served.
- You are not happy with the cleanliness of your doctor’s or other provider’s clinic or facility.
- You do not believe we have given you a notice that we are required to give.
- You think the written information we have given you is hard to understand.
- You asked us to give you a “fast coverage decision” or “fast appeal” and we said that we will not.
- You think we are not meeting the deadlines for giving you a coverage decision or an answer to an appeal you have made.
- When a coverage decision we made is reviewed and we are told that we must cover or reimburse you for certain medical services or drugs, there are deadlines that apply. If you think we are not meeting these deadlines, you can make a complaint.
- When our plan does not give you a decision on time, we are required to forward your case to the Independent Review Organization. If we do not do that within the require deadline, you can make a complaint.
To make a complaint you can fill out the electronic Complaint Submission Form. You can also contact Member Services to file a complaint. If you do not wish to call (or you called and were not satisfied), you can put your complaint in writing and send it to us. If you put your complaint in writing, we will respond to your complaint in writing.
You can also submit a complaint about PHP directly to Medicare. (By clicking on this link, you will be taken to the Medicare website.) Medicare takes your complaints seriously and will use this information to help improve the quality of the Medicare program.
If you have any other feedback or concerns, or if you feel the plan is not addressing your issue, please call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.
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