• Overview
• Grievances (Complaints)
  • Making a Complaint
• Problems/Concerns about Part C Medical Benefits and Coverage
  • Coverage Decisions
  • Appeal a Coverage Decision
• Problems/Concerns about the Part D Prescription Drug Benefit
  • Coverage Decision/Exceptions
  • Appeal a Coverage Decision

MAKING A COMPLAINT

Contact us promptly – either by phone or in writing;

• Usually calling Member Services is the first step – If there is anything else you need to do Member Services will let you know. Call 1-877-615-4022. Hearing Impaired call TRS Relay 711. Hours of operation are 7 days a week, 8 a.m. to 8 p.m.
• If you do not wish to call (or you called and were unsatisfied), you can put your complaint in writing and send it to us. If you do this, it means that we will use our formal procedure for answering grievances. Here’s how it works:
  • You may send you written complaint via mail, fax or e-mail to FHCP’s Member Services Department:

Florida Health Care Plans
Attn: Member Services
1340 Ridgewood Avenue
Holly Hill, FL 32117
Fax#: 386-676-7149
E-mail: Member Services click here

If you need assistance in preparing a written grievance, a Member Services Representative will work with you and will forward you a copy of the written document when completed for your signature, along with a self-addressed stamped envelope for returning the document to FHCP.

• Whether you call or write, you should contact Member Services right away. The complaint must be made within 60 days after you had the problem you want to complain about

  We will write to you to let you know how we have addressed your concern within 30 days or within 72 hours for a (fast) expedited grievance, verbal notification will be provided to you within 24 hours for an expedited grievance related to an appeal. In come instances we will need additional time to address your concern.

  If you are not satisfied with FHCP’s determination or the action taken to address your initial concern, you may requires a separate review by the FHCP Grievance Committee by submitting a written request within 30 days to the above address, Attention: Grievance Supervisory. The Grievance Supervisor will acknowledge the receipt of the request, and schedule the review within 30 days, and present the grievance along with your written request and any additional documentation submitted by you, to the Committee.  You will be notified of the time and date of the Committee and be given an opportunity to present you case in person to the Committee. The Committee will render a decision within 30 days of the date of review.

• Members of the Medvantage Plan please refer to Chapter 7 of your Evidence of Coverage for complete information on filing a complaint (grievance).
• Members of the Medvantage Rx Plan please refer to Chapter 9 of your Evidence of Coverage for complete information on filing a complaint (grievance).
• Members of the Medvantage Rx Plus Plan please refer to Chapter 9 of your Evidence of Coverage for complete information on filing a complaint (grievance).