A
grievance is the type of complaint you make
if you have any other type of problem with Presbyterian Senior Care (HMO), Presbyterian UltraFlex (HMO-POS), Presbyterian MediCare PPO, Presbyterian Dual Plus (HMO D-SNP) or one of our plan practitioners and providers. For example, you would file a grievance if you have a problem with things such as the quality of your care, waiting times for appointments or in the waiting room, the way your doctors or others behave, being able to reach someone by phone or get the information you need, or the cleanliness or condition of the doctor's office.
How to file a Grievance:
If you have a complaint, we encourage you to call PCSC first with any questions. We will try to resolve any complaint that you might have over the phone, or, you may submit a written complaint. We have a formal procedure to review your complaints. We call this our formal grievance process. Once we receive your grievance, Presbyterian Health Plan will write you to let you know how we have addressed your concern within thirty (30) days after we receive your grievance. In some instances, we may need additional time to address your concern. If additional time is needed, we will keep you informed of how your grievance is being handled. No matter which process you use to notify Presbyterian Health Plan, we must keep track of all grievances or complaints in order to report our data to CMS and to our members, upon request.
Marketing complaints may be filed with Presbyterian Health Plan or by contacting Medicare. It is important to provide an agent or broker name, if possible. You can call Medicare at
1-800-MEDICARE, 24 hours a day, 7 days a week, except some federal holidays. TTY users should call
1-877-486-2048.
505-923-6060 or
1-800-797-5343 (TTY
711)
Hours: 8 a.m. to 8 p.m., Sunday - Saturday
You may send your grievance request letter to:
Grievance and Appeals Coordinator
P.O. Box 27489
Albuquerque, NM 87125-7489
Or Fax to: 505-923-6111
You may also submit your grievance electronically