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MEMBER RESOURCES > APPEALS OR EXCEPTIONS

Appoint a representative, file a grievance or appeal,
request a coverage determination, and more.

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File a Grievance

 

File a standard grievance over the phone or in writing to:

Fax: 1-833-610-2380

Mail:

Align Senior Care
Appeals and Grievances Department
PO Box 40
Glen Burnie, MD 21060

File a complaint directly to Medicare:

Fill out this form
What is a grievance?

A grievance is a type of complaint that does not involve payment or denial of services by Align Senior Care or Contracting Medical Provider. For example, you would file a grievance if:

  • You have a problem with things such as the quality of your care during a hospital stay;
  • You feel you are being encouraged to leave your plan;
  • Waiting times on the phone, at a network pharmacy, in the waiting room, or in the exam room are too long;
  • Waiting too long for prescriptions to be filled;
  • The way your doctors, network pharmacists or others behave;
  • Not being able to reach someone by phone or obtain the information you need; or
  • Lack of cleanliness or the condition of your doctor’s office.
Who can file a grievance?

A grievance may be filed by:

  • You (the member)
  • Your authorized representative
Why file a grievance?

You are encouraged to file a grievance when you have a complaint about your health plan, customer service, or the quality of care you received that is not related to a coverage or payment decision.

When can a grievance be filed?

You may file a grievance as soon as the incident occurs but no later than sixty (60) calendar days of the date of the incident.

Note: The sixty (60) day limit may be extended for good cause. Include in your written request the reason why you could not file within the sixty (60) day time frame.

Can I expedite a grievance?

You may be able to file an expedited grievance by calling:

An expedited grievance may be filed when:

  • You disagree with our decision to extend the timeframe for resolving your grievance; or
  • You disagree with our decision not to process your request on an expedited basis.

In these situations, you may file an expedited grievance and receive a response within 24 hours of receipt.

What happens next?

We will review your Grievance and provide a resolution as expeditiously as possible but no later than thirty (30) days from your initial request. If additional information is needed and the delay is in your best interest, or if you ask for more time, we can take up to 14 more days to respond to your grievance.

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