The formal name for making a complaint is “filing a grievance.” You should utilize the complaint process for problems related to quality of care, waiting times, and the customer service you receive. You can file a grievance or you can authorize someone else to do so on your behalf.
File a grievance for issues related to:
- Quality of your medical care
- ᏂᎯ ᎨᏒᎢ ᏂᏣᎵᎮᎵᏍᏛᎾ ᎠᏠᏯᏍᏗ ᎾᏍᎩ ᎢᏲᏍᏓ ᎥᎿᎢ ᎾᏍᎩ ᎠᎦᏎᏍᏙᏗ ᏂᎯ ᏣᎩᏍᏒᎢ (ᎤᏠᏯᏍᏗ ᎠᎦᏎᏍᏙᏗ ᎾᎿᎢ ᎾᏍᎩᎾ ᏧᏂᏢᎩ ᎨᏥᏍᏆᏂᎪᏙᏗᏱ)?
- Respecting your privacy
- ᏂᎯ ᎰᏩᎮᎵᎢ ᎾᏍᎩᎾᎢ ᎩᎶᎢ ᎥᏝ ᏣᏤᎵ ᏱᏓᎾᏓᏂᎸᎨᎢ ᏣᏤᎵᎦᏯ ᎾᎢ ᎤᏕᎵᏓ ᎠᎴᏃ ᎠᏯᏙᏍᏗᎢ ᎧᏃᎮᏢᎥᏍᎩ ᏂᎯ ᏄᏰᎵᏛ ᎾᏍᎩᎾᎢ ᏂᎯ ᏂᎵᏍᎬᎢ ᎡᎵᏍᏗ ᎾᏍᎩ ᎤᏕᎵᏛ ᏱᎩ?
- Disrespect, poor customer service, or other negative behaviors
- ᏂᏚᏅᏅ ᎦᎶᎢ ᏄᎵᏍᏔᏅ ᎬᏍᎦᏍᏓᎩ ᎨᏒᎢ ᎠᎴᏃ ᏂᏚᏬᎯᏳᏒᎾ ᎾᎢ ᏂᎯ?
- ᏂᎯᏍᎪᏃ ᏂᏣᎵᎮᎵᏍᏛᎾ ᎬᏗ ᎤᏩᏍᎩ ᎢᏯᏓᏛᏁᏗ ᏂᎨᏨᏁᎲᎩ?
- Waiting times
- ᏂᎯᏍᎪᏃ ᎤᏦᏎᏗ ᏂᏣᎵᏍᏓᏁ ᎾᏍᎩ ᏗᏒᏍᏙᏗ Ꭲ ᎠᎴᏃ ᎪᎯᏗ ᏣᎦᏘᏗᏍᏗ ᎯᎩᏍᎬᎢ?
- ᏂᎯ ᎾᏍᎩ ᏣᎦᏘᏗᏍᏗ ᏁᏣᏁᎢ ᎪᎯᏗ ᎾᎢ ᎠᏂᎦᎾᎦᏘ ᏂᎨᏨᏁᎢ, ᏅᏬᏘ ᏗᎾᏓᏁᎯ, ᎠᎴᏃ ᏐᎢ ᏅᏩᏙᎯᏯᏛ ᏫᏓᏤᏢ ᎢᏯᎾᏛᏁᎯ, ᎠᎴᏃ ᎬᏗ ᎣᎦᏤᎵ ᎤᏩᏍᎩ ᎢᏯᏓᏛᏁᏗ ᎠᎴᏃ ᏐᎢ ᏧᏂᎸᏫᏍᏓᏁᎯ ᎤᎿᎢ ᎾᏍᎩ ᎠᏍᏓᏩᏛᏍᏗ?
- Cleanliness
- ᏂᎯᏍᎪᏃ ᏂᏣᎵᎮᎵᏍᏛᎾ ᎾᏍᎩ ᏅᏓᏅᎦᎸᏒᎾ ᎠᎴᏃ ᏄᏍᏗᏓᏅᎢ ᎾᏍᎩ ᏅᏬᏘ ᎤᏂᏍᏆᏂᎪᏙᏗ, ᎨᏣᎪᎵᏰᏗ, ᏧᏂᏢᎩ ᏕᎨᏥᏍᏆᏂᎪᏙᏗᏱ, ᎠᎴᏃ ᎦᎾᎦᏘ ᏄᏅᏅ ᏧᏂᎸᏫᏍᏓᏁᏗᎢ?
- Information you get from us
- ᏦᎯᏳᏍᎪᏃ ᏂᎦᏛᏉ Ꮭ ᏱᏨᏁᎳ ᎠᏓᏃᎯᏎᎯ ᎾᏍᎩᎾᎢ ᏂᎦᏛᏉ ᎨᏒᎢ ᏂᎯ ᎠᏎᎢ ᎢᏨᏁᏗᎢ?
- ᎾᏍᎩᏍᎪᏃ ᏱᏑᎵᏒ ᎾᏍᎩ ᎪᏪᎳᏅᎢ ᎧᏃᎮᏢᎥᏍᎩ ᏂᎦᏛᏉ ᎢᏨᏅᏁᎸᎩ ᎾᏍᎩ ᎠᏍᏓᏱ ᎪᏟᏍᏗᏱ?
Contact us promptly by phone or in writing. Usually calling Customer Service is the first step. If you do not wish to call (or you called and were not satisfied) you can put your complaint in writing and send it to us.
You can file a grievance in one of the four following ways:
- Contact Us
- Write: Wellcare Health Plans, Inc.
Attn: Grievance Department
P.O. Box 31384
Tampa, FL 33631-3384 - Online: A grievance can also be submitted through the Contact Us Form
- To access the Contact Us Form, select "Submit a question online" and follow the prompts
- Fax: 1-866-388-1769
As a member of our plan, you have the right to file an expedited grievance (fast complaint) for specific circumstances:
- A member can request an expedited grievance only if the plan downgrades their expedited appeal or authorization to a standard; or if the plan takes an extension on an authorization or appeal, and the member disagrees.
If you are making a complaint because we denied your request for a “fast coverage decision" or "fast appeal", your complaint will be sent to the appeals team. After review, the appeals team will then forward your complaint to the grievance team to make a decision. If you have a fast complaint, we will give you an answer within 24 hours.
Quality Improvement Organizations
You can make your complaint to the Quality Improvement Organization. If you prefer, you can also make a complaint about the quality of care you received directly to this organization (without making a complaint to us). To find the name, address, and phone number of the Quality Improvement Organization in your state, please read your Evidence of Coverage. If you make a complaint to this organization, we will work together with them to resolve your complaint.
You can also submit a complaint about our plan directly to Medicare. To submit a complaint to Medicare using the Medicare Complaint Form. Medicare takes your complaints seriously and will use this information to help improve the quality of the Medicare program. For help with Medicare-related complaints, grievances, and information requests, contact the office of the Medicare Beneficiary Ombudsman (MBO). If you have any other feedback or concerns, or if you feel the plan is not addressing your issue, please call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, seven days a week. TTY users can call 1-877-486-2048.
If you would like information on how to obtain an aggregate number of grievances, appeals, and exceptions filed with our plan, contact us for more information.
