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Grievances (Complaints)

What is a grievance?

A grievance (complaint) is used for certain types of problems. This includes concerns about:

Examples of when you may file a complaint:

You feel your privacy was not respected or your personal information was shared without permission
Someone treated you in a rude or disrespectful way
You had to wait too long on the phone or for medical care
You did not receive a required notice
You asked for a fast (expedited) decision, and we said no
You believe we did not meet required timeframes to give you a decision or respond to an appeal

You must file your complaint within 60 days of the event that caused the problem.

We review each complaint carefully and respond as quickly as your health needs require.

If you call us, we may be able to resolve your issue during the call
If you prefer, you can send your complaint in writing
- If you write to us, we will also respond in writing

Fast (expedited) complaints:
- We will respond within 24 hours if your complaint is about our refusal to give a fast decision and you have not yet received care
All other complaints:
- We will respond within 30 days
In some cases, we may take up to 14 extra days if:
- You ask for more time, or
- We need more information and the delay is in your best interest

Contact us by:
Phone	1-866-535-8343 TTY: 711 FAX: 1-713-442-9536
Mail	KelseyCare Advantage Attn: Appeals and Grievances Department P.O. Box 841569 Pearland, TX 77584-9832
For information about the total number of grievances filed with KelseyCare Advantage, please contact KelseyCare Advantage using the phone numbers listed above. You can submit a complaint directly to Medicare. You can also call Medicare at 1-800-MEDICARE (1-800-633-4227)