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Freedom Health enrollee’s may elect to file a grievance orally or in writing. The Plan accepts grievances no later than 60 days after the event or incident that caused the grievance to occur. To make an oral grievance, the enrollee should call the Member Services toll free number at 1-800-401-2740, Monday through Friday, from 8:00 a.m. to 5:00 p.m. For TTY/TDD assistance, enrollee’s should call 1-800-955-8771.
Written grievances may be mailed to:
Freedom Health, Inc.,
P.O. Box 1162
Pinellas Park, Florida 33780
Attention: Appeals & Grievances Department.
The enrollee may fax a written grievance to Freedom Health at (727) 471-2108.
Members may file quality of care grievances with the quality improvement organization (QIO) in Florida beyond the 60-day time frame. The Florida Medical Quality Assurance (FMQAI) may be reached toll free at 1-800-844-0795 or in writing at: FMQAI, 5102 W. Kennedy Blvd., Suite 900, Tampa, Florida 33609.
Enrollee’s may appoint a representative to act on their behalf during the grievance process. Please see the section entitled, “Instructions on Appointing a Representative” for information on how to proceed.
Freedom Health will handle any oral or written grievance in the following manner:
- Accept all information or evidence concerning the grievance.
- Respond within 24 hours to an expedited (fast) grievance when Freedom Health has refused to grant a request for an expedited (fast) coverage determination or expedited (fast) redetermination and the enrollee has not received the drug in dispute.
- Notify all parties of the results of investigations as quickly as the case requires, based on the enrollee’s health status, but not later than 30 days after Freedom Health received the oral or written grievance.
- Freedom Health may choose to extend the 30-day response time frame up to 14 days under two circumstances: (1) if the enrollee requests the extension or (2) Freedom Health justifies a need for additional information. Freedom Health will document how the delay is in the best interest of the enrollee. The enrollee will be notified of the extension in writing.
- The enrollee is notified of the results of the grievance review as follows:
- Any grievance submitted in writing will have a written response.
- Orally submitted grievances will be responded to either orally or in writing, unless the enrollee specifically requests a written response.
- Quality of care grievances will be responded to in writing and the letter will include the right to file a written complaint with the QIO.
For more details on the formal Freedom Health grievance process, please click the link below for the current Explanation of Coverage. The grievance process for Part D benefits can be found in Section 12.
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