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 you can authorize someone else to do so on your behalf.
Maghain ng karaingan para sa mga isyung nauugnay sa:
- Kalidad ng iyong medikal na pangangalaga
- Hindi ka ba masaya sa kalidad ng pangangalagang natanggap mo (kabilang ang pangangalaga sa ospital)?
- Paggalang sa inyong privacy
- Sa tingin mo ba ay may hindi rumespeto sa karapatan mo sa privacy o kaya ay may nagbahagi ng impormasyon tungkol sa iyo na sa tingin mo ay dapat na kumpidensyal?
- Kawalan ng respeto, pangit na serbisyo sa customer, o iba pang negatibong pag-uugali
- May nantrato ba sa iyo nang masama?
- Hindi ka ba masaya sa kung paano ka pinakitunguhan ng Serbisyo sa Customer?
- Mga tagal ng paghihintay
- Nagkakaproblema ka ba sa pagkuha ng appointment, o masyado bang matagal ang iyong paghihintay para makakuha nito?
- Napaghintay ka ba nang matagal ng mga doktor, pharmacist, o iba pang propesyonal sa pangangalagang pangkalusugan, o ng aming Serbisyo sa Customer o iba pang staff ng plano?
- Kalinisan
- Masaya ka ba sa kalinisan o kondisyon ng parmasya, klinika, ospital, o klinika ng doktor?
- Impormasyong nakukuha ninyo mula sa amin
- Sa tingin mo ba ay may hindi kami naibigay sa iyo na abiso na dapat naming ibigay?
- Sa tingin mo ba ay mahirap maunawaan ang mga nakasulat na impormasyong ipinadala namin sa iyo?
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.
Puwede kayong maghain ng karaingan sa isa sa mga sumusunod na apat na paraan:
- Contact Us
- Write: Wellcare Health Plans, Inc.
Attn: Grievance Department
P.O. Box 31384
Tampa, FL 33631-3384 - Online: A grievance can also be submitted through the Contact Us Form
- To access the Contact Us Form, select "Submit a question online" and follow the prompts
- Fax:1-866-388-1769
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 an authorization or appeal, and the member disagrees.
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.
Mga Organisasyon ng Pagpapahusay ng Kalidad
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.
You can also submit a complaint about our plan directly to Medicare. To submit a complaint to Medicare using the Medicare Complaint Form. Medicare takes your complaints seriously and will use this information to help improve the quality of the Medicare program. For help with Medicare-related complaints, grievances, and information requests, contact the office of the Medicare Beneficiary Ombudsman (MBO). 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.
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.
