Filing a Grievance
You have the right to tell us if you’re not happy with your care. This is called a complaint or grievance. We hope our members will always be happy with us and our providers. But if you are not happy, please let us know. A complaint or grievance is an expression of dissatisfaction about any matter other than an Adverse Benefit Determination (Proposed Action/Denial):
A Member Complaint or Grievance can be filed if or when:
- A Member is dissatisfied with a provider services or care
- Provider and/or staff have behavior that is inappropriate or discourteous
- Provider has limited availability to members
- Your appeal was not processed timely
You have the right to file a Complaint or Grievance. We cannot treat you differently because you have filed a Complaint or Grievance. Your benefits will not be affected.
The member or the member’s authorized representative may file a Complaint or Grievance with Peach State either orally or in writing. A provider cannot file a complaint or grievance on behalf of a member without written consent from the member.
To file a Complaint or Grievance, or If you need help filing the Complaint or Grievance, Peach State Health Plan can help you:
Call Member Services at 1-800-704-1484, TTY/TDD 1-800-255-0056. They can also help you if you need this information translated. Or write us a letter telling us why you are not happy. Be sure to include:
- Your first and last names.
- Your Peach State ID card number.
- Your address and telephone number.
Mail the letter to:
Peach State Health Plan
Grievance & Appeals Coordinator
1100 Circle 75 Pkwy
Atlanta, GA 30339
If you would rather have someone speak for you, let us know. Another person can act for you.
When will Peach State Health Plan acknowledge my grievance (oral or written)?
Once Peach State Health Plan gets your grievance (oral or written), we will send you a letter within ten (10) calendar days. This letter will tell you the date we got your grievance.
When will Peach State Health Plan tell me the decision about my grievance?
We will look into your grievance and try to make a decision right away. If not, we will give you a written decision within ninety (90) calendar days after we get your grievance or sooner if your health condition calls for it.