What is a Grievance?
A Grievance is a complaint for any service other than an organization determination. A complaint is telling us that you are not happy with a Medicare health plan or contracted provider offered health care services, even if nothing can be done right away. An enrollee or their appointed representative may make the complaint, either orally or in writing, to a Medicare health plan, provider, or facility. An expedited grievance may also include a complaint that a Medicare health plan did not allow to expedite an organization determination or reconsideration, or called upon to allow more time to file a complaint for an organization determination or reconsideration.
It is a way of telling us that you are not happy about wait times at the doctor’s office, how long it took for you to get an appointment, cleanliness of the doctor’s office, behavior by doctor’s office staff, or the quality of care you got by a doctor.
You can tell us that you are not happy about our decision when you asked for certain services and our payment. If you are not happy with anything about us or our providers you may file a complaint/grievance. You need to file your complaint/grievance within 60 days of when it happened. If you have a good reason for being late in turning in a complaint/grievance, let us know and we will choose whether or not to give you more time for turning in a complaint/grievance.
Turning in a Grievance
You or your appointed representative can file a grievance by:
- Calling our Fidelis SecureLife (MMP) Member Services team at 1-844-239-7387. Hours are from 8 a.m. to 8 p.m., seven days a week. TTY users call 711. On weekends and on state or federal holidays, you may be asked to leave a message. Your call will be returned within the next business day.
- Fax your complaint to us at 1-844-273-2671.
- Write us a letter (include your name, Fidelis SecureLife (MMP) ID number, address and phone and why you are not happy) and mail it to:
Fidelis SecureLife (MMP)
Attn: Medicare Appeals and Grievances
7700 Forsyth Blvd
St Louis, MO 63105
- Calling Medicare 1-800-MEDICARE (1-800-633-4227) TTY 1-877-486-2048. Calls to this number are free, 24 hours a day, 7 days a week.
- Online by going to www.Medicare.gov (Please note: By clicking on this link, you will be leaving the Fidelis SecureLife (MMP) website.)
Click on the Complaint Form link above to open a form that you can print and fill out to file a member complaint. The form will tell you how to fill it out.
Last Updated: 09/30/16