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How to file a grievance with Preferred Care

We want to make your Preferred Care health plan simple and easy to use. If you have a complaint about a problem with Preferred Care or one of our providers, please call us. We want to be responsive to your concerns, and will try to resolve your complaint over the phone. You can call us for any of these reasons:

• A problem with the quality of medical care you receive, during a hospital stay or otherwise.
• A complaint about copayment or coinsurance amounts.
• If you feel that you are being encouraged to leave Preferred Care.
• A problem with the customer service you receive from Preferred Care.
• A problem with how long you have to spend waiting on the phone, in the waiting room, or in the exam room at your doctor’s office.
• A problem with getting appointments when you need them, or having to wait a long time for an appointment.
• Disrespectful or rude behavior by doctors, nurses, receptionists or other staff.
• Cleanliness or condition of doctors’ offices, clinics or hospitals.
• If we tell you we are taking an extension of time to review an appeal or a request by your provider for approval of a service.
• If we refuse to expedite an appeal or a request by your provider for approval of a service.

Standard Grievances

In a standard grievance we will respond to your concern within 30 days of receipt of your grievance, either by phone or letter. In some instances, we will need more than 30 days to properly address your concern. If more than 30 days is needed, we will send you a notice explaining why.

Expedited (Fast) Grievances

We will respond to your concern within 24 hours for a complaint about not agreeing to give you a fast appeal or not answering a request by your provider for fast approval of a service. We also will respond within 24 hours for a complaint about having told you we need more time to complete an appeal or answer a request by your provider for approval of a service.

For more information about appeals, refer to your Evidence of Coverage booklet (your contract).

If you are not satisfied with our response to your grievance, you may request a second level of review by sending a letter to Preferred Care Member Services, Attn: Service Recovery. Your grievance will be presented to a grievance committee for resolution. The committee is made up of reviewers who were not involved in the first-level review. We will follow up with you by phone or letter within 30 days of receipt of your request. We record all complaints to monitor trends and patterns when requested.

• Click here for complete Preferred Care Grievance or Appeal information
• You may request a printed copy of this Grievance or Appeal information by contacting Preferred Care Member Services.

To reach Preferred Care Member Services

• Visit the Contact Member Services Web page for information about contacting Member Services by phone or e-mail.
• Or write to us at: Preferred Care, Member Services, 259 Monroe Avenue, Rochester, NY 14607.