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 you the 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 from receipt. Following resolution, the party who submitted the grievance will be notified of the review completion.
Grievances may include such issues as:
The quality of health care or services (i.e., accessibility, appropriateness, level of care, continuity, timeliness of care) The demeanor or behavior of providers and their staff 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 A 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) The nature of the concern or complaint Details describing the event or issue Any appropriate supporting documents
File grievances with Humana Military. See Figure 6.3 for grievance filing information. Figure 6.3 Regional Grievance Filing Information
TRICARE North Region
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TRICARE South Region
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TRICARE West Region
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All grievances should be addressed to:
Health Net Federal Services, LLC
TRICARE Grievances
P.O. Box 870150
Surfside Beach, SC 29587-9750 |
Address all grievances to:
Regional Grievance Coordinator
Humana Military Healthcare Services
8123 Datapoint Drive
Suite 400
San Antonio, TX 78229 |
Address all grievances to:
TriWest Healthcare Alliance Corp.
Attn: Customer Relations Dept.
P.O. Box 42049
Phoenix, AZ 85080 |
Submit by fax:
1-888-317-6155
Submit online
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For behavioral health care concerns, send your information to:
Grievance Specialist
ValueOptions
P.O. Box 551188
Jacksonville, FL 32255-1188 |
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