Commonwealth Care Alliance

Senior Care Options Program (HMO SNP)

Pharmacy » Exceptions, Appeals & Grievances » Grievance

Grievance

What is a grievance?

A grievance is a complaint about anything other than benefits, coverage, or payment. You would file a grievance if you have any type of problem with the Commonwealth Care Alliance drug benefits or one of our network pharmacies that does not relate to coverage for a prescription drug. For example, you would file a grievance if you have a problem with things such as waiting times when you fill a prescription, the way your network pharmacist or others behave, being able to reach someone by phone or get the information you need, or the cleanliness or condition of a network pharmacy.

Filing a grievance or complaint

You or your appointed representative may call, fax, write or file a grievance or complaint.

Call our Member Services team at 1-866-610-2273 (TTY 711)
We are available 8 a.m. to 8 p.m., 7 days a week

Fax your grievance to 617-426-1311

Mail your grievance to:
Commonwealth Care Alliance
Member Service / Appeals and Gievances
30 Winter Street
Boston, MA 02108

You can also submit your complaint directly to Medicare by using their online form* or call 1-800-MEDICARE (1-800-633-4227). TTY/TDD users can call 1-877-486-2048. 24 hours a day, 7 days a week.

Quality of care complaints

For quality of care complaints you may contact Commonwealth Care Alliance (listed above) or Livanta (Massachusetts’ Quality Improvement Organization) at 1-866-815-5440 (TTY 1-866-868-2289)

Review your Evidence of Coverage (Member Handbook) for more information about grievances (Chapter 8)

*When you click this link, you will leave Commonwealth Care Alliance’s website.

 

Last Updated 07/29/2013