The formal name for “making a complaint” is “filing a grievance.” You should utilize the complaint process for problems related to quality of care, waiting times, and the customer service you receive. You can file a grievance or someone you authorize can do so on your behalf.
File a grievance for issues related to:
- Quality of your medical care
- Are you are unhappy with the quality of the care you received (including care in the hospital)?
- Respecting your privacy
- Do you believe that someone did not respect your right to privacy or shared information about you that you feel should be confidential?
- Disrespect, poor customer service, or other negative behaviors
- Has someone been rude or disrespectful to you?
- Are you unhappy with how Customer Service has treated you?
- Waiting times
- Are you having trouble getting an appointment, or waiting too long to get it?
- Have you been kept waiting too long by doctors, pharmacists, or other health professionals, or by our Customer Service or other staff at the plan?
- Are you unhappy with the cleanliness or condition of a pharmacy, clinic, hospital, or doctor's office?
- Information you get from us
- Do you believe we have not given you a notice that we are required to give?
- Do you think written information we have given you is hard to understand?
Contact us promptly by phone or in writing. Usually calling Customer Service is the first step. 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. The complaint must be made within 60 days after you had the problem you want to complain about.
A grievance can be submitted through the Contact Us Form.
You can also submit a complaint about our plan directly to Medicare. To submit a complaint to Medicare, go to medicare.gov. 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), 24 hours a day, seven days a week. TTY users can call 1-877-486-2048.
As a member of our plan, you have the right to file an expedited grievance (fast complaint) for specific circumstances:
- A member can request an expedited grievance only if the plan downgrades their expedited appeal or authorization to a standard or if the plan takes an extension on a grievance and the member disagrees.
An expedited grievance (fast complaint) is resolved within 24 hours. A standard grievance is generally resolved within 30 days from the date we receive your request unless your health or condition requires a quicker response. If additional information or an extension is required, we may extend that timeframe by up to 14 days.
If you are making a complaint because we denied your request for a “fast coverage decision" or "fast appeal", your complaint will be sent to the appeals team. After review, the appeals team will then forward your complaint to the grievance team to make a decision. If you have a fast complaint, we will give you an answer within 24 hours.
You can file a grievance in one of the four following ways:
- Call us using the number on the back of your Member ID card
- Fax: 1-866-388-1769
Wellcare Health Plans, Inc.
Attn: Grievance Department
P.O. Box 31384
Tampa, FL 33631-3384
You can make your complaint to the Quality Improvement Organization. If you prefer, you can also make a complaint about the quality of care you received directly to this organization (without making a complaint to us). To find the name, address, and phone number of the Quality Improvement Organization in your state, please read your Evidence of Coverage. If you make a complaint to this organization, we will work together with them to resolve your complaint.
If you would like information on how to obtain an aggregate number of grievances, appeals, and exceptions filed with our plan, contact us for more information.