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Filing a Grievance
A grievance is a written complaint or concern dealing with a non-appealable issue regarding a perceived failure by any member of the health care delivery team—including TRICARE-authorized providers, military providers, A TRICARE contractor, 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, parent or 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 resolved no later than 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:
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The quality of certain aspects of health care or services, such as accessibility, appropriateness, level, continuity, or timeliness of care; effectiveness or outcome
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The demeanor or behavior of providers and their staff
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The performance of any part of the health care delivery system
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Practices related to patient safety
When filing a grievance, include the following information:
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The beneficiary’s name, address, and telephone number
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Sponsor’s SSN
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Beneficiary’s date of birth
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Beneficiary’s signature
A description of the issue or concern must include:
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The date and time of the event
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Name of the provider(s) and/or person(s) involved
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Location of the event (address)
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The nature of the concern or complaint
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Details describing the event or issue
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Any appropriate supporting documents
File your grievance with Humana Military. See Figure 5.3 for details.
Figure 5.3 Regional Grievance Filing Information
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TRICARE North Region
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TRICARE South Region
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TRICARE West Region
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Submit your grievance in writing to:
Health Net Federal Services, Inc.
c/o PGBA, LLC/TRICARE Grievance
P.O. Box 870150
Surfside Beach, SC 29587-9750 |
Submit your grievance in writing to:
Regional Grievance Coordinator
Humana Military Healthcare Services
8123 Datapoint Drive
Suite 400
San Antonio, TX 78229 |
Submit your grievance in writing to:
TriWest Healthcare Alliance
Attn: Customer Relations Dept.
P.O. Box 86036
Phoenix, AZ 85080 |
| Submit online |
For behavioral health care concerns, send your information to:
Grievance Specialist
ValueOptions
P.O. Box 551188
Jacksonville, FL 32255-1188 |
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Submit by fax:
1-888-317-6155 |
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