You can file a grievance if you have a complaint about:
- The quality of care you receive.
- The timeliness of service.
- Any other concern (except for the coverage or payment issues listed above).
If you have an issue related to what is covered for medical services, or if you or your appointed representative wish to file a grievance, please visit our Comuníquese con nosotros de la página.
Important: You must file a grievance with us no later than 60 days after the event or incident in question.
You may also contact Customer Service if you want to know about the number of appeals, grievances or exceptions filed with the plan.
Here are examples of reasons you may file a grievance:
- Siente que lo incitamos a renunciar (cancelar la cobertura) a nuestra cobertura.
- Concerns with customer service.
- Long wait times for a pharmacy or medical office.
- Disrespectful or rude behavior by pharmacists or medical staff.
- La limpieza o el acondicionamiento de la farmacia o el consultorio médico.
- You do not agree with our decision not to expedite your request for an expedited coverage determination or redetermination.
- Considera que nuestros avisos y demás material escrito son difíciles de entender.
- The plan sponsor (BCBSIL) failed to give you a decision within the required time frame.
- BCBSIL did not forward your appeal case for an independent review if we didn’t give you a decision within the required time frame.
- We did not provide required notices, and/or the notices did not comply with Centers for Medicare & Medicaid Services (CMS) standards.
Resolución de problemas
A grievance must be filed with us no later than 60 days after the event or incident in question.
Resolve by Phone
Intentamos resolver cualquier queja que tenga por teléfono. Si Servicio al Cliente no puede resolver su problema por teléfono, disponemos de un proceso formal para revisar sus quejas. Este proceso es muy sencillo, por lo que obtendrá una respuesta rápida.
- Si su problema no se resuelve la primera vez que llama, se lo remitirá a un coordinador de inconformidades para que lo resuelva.
- Si su inconformidad tiene que ver con la calidad de la atención médica que recibió, recibirá una respuesta por escrito.
- You will be sent a written response as quickly as your case requires based on your health status. This will be no later than 30 calendar days after we receive your complaint.
- We may add to the time frame by up to 14 calendar days if you request an extension.
- If there's a need for more information and the delay is in your best interest, the reply can take longer. When we extend the deadline, we will let you know right away the reason(s) for the delay in writing.
Por correo
Puede presentar una inconformidad por escrito enviando una carta por correo o por fax informándonos sobre ella.