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Grievances and Member Feedback

Category: File a Grievance

SCAN Health Plan is committed to maintaining high levels of member satisfaction. We continuously strive to improve our services through member feedback. We encourage our members who require assistance with problem solving, to call our Member Services at 1-800-559-3500 (TTY User: 711) 8:00 a.m. – 8:00 p.m. PST – Monday – Friday, 9:00 a.m. – 4:00 p.m. – Saturday. Messages received on holidays and outside of our business hours will be returned within 1 business day.

To find out more about the Grievance Process, please refer to your Evidence of Coverage (EOC).

If you have a complaint, you or your representative may call the phone number for Part C Grievances (for complaints about medical care or services covered under Medicare Part C) and/or Part D Grievances (for complaints about drugs covered under Medicare Part D) listed in the EOC. We will try to resolve your complaint over the phone. If you ask for a written response, file a written grievance, or your complaint is related to quality of care, we will respond in writing to you. If we cannot resolve your complaint over the phone, we have a formal procedure to review your complaints. We call this the grievance procedure.

As a SCAN member, you may file the grievance yourself or appoint someone to do it for you. This person you appoint would be your authorized representative. You can appoint a relative, friend, advocate, doctor, attorney, or other person to act for you. If you already have someone authorized under state law to act for you, this person can file the grievance on your behalf.

The grievance must be submitted within 60 days of the event or incident. We must address your grievance as quickly as your case requires based on your health status, but no later than 30 days after receiving your complaint. We may extend the time frame by up to 14 days if you ask for the extension, or if we justify a need for additional information and the delay is in your best interest. If we deny your grievance in whole or in part, our written decision will explain why we denied it, and will tell you about any dispute resolution options you may have. 

To find instructions on how to complete a grievance click here.

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