A grievance is a written complaint or concern about a non-appealable issue regarding a perceived failure by any member of the health care delivery team—including TRICARE-authorized providers, military providers, regional contractors, or subcontractor personnel—to provide appropriate and timely health care services, access, or quality, or to deliver the proper level of care or service.
The grievance process allows full opportunity to report, in writing, any concern or complaint regarding health care quality or service. Any TRICARE civilian or military provider; TRICARE beneficiary; sponsor; or parent, guardian, or other representative of an eligible dependent child may file a grievance. Humana Military is responsible for the investigation and resolution of all grievances. Grievances are generally resolved within 60 days of receipt. Following resolution, the party who submitted the grievance will be notified of the review completion.
Grievances may include such issues as:
- The quality o f health care or services (i.e., accessibility, appropriateness, level of care, continuity, timeliness of care)
- The demeanor or behavior of providers and their staffs
- The performance of any part of the health care delivery system
- Practices related to patient safety
When filing a grievance, include the following:
- The beneficiary’s name, address, and telephone number
- Sponsor’s SSN
- Beneficiary’s date of birth
- Beneficiary’s signature
Description of the issue or concern must include:
- Date and time of the event
- Name(s) of the provider(s) and/or person(s) involved
- Location of the event (address)
- Nature of the concern or complaint
- Details describing the event or issue
- Any appropriate supporting documents
File your grievances with Humana Military. See Figure 6.3 for filing information. Figure 6.3 South Region Grievance Filing Information
Submit your grievance in writing to:
Regional Grievance Coordinator
Humana Military Healthcare Services
8123 Datapoint Drive
Suite 400
San Antonio, TX 78229 |
For behavioral health care concerns, send your information to:
Grievance Specialist
ValueOptions
P.O. Box 551188
Jacksonville, FL 32255-1188 |
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