The Peoples Health grievance process is as follows:
- We must receive the members’ complaint within 60 calendar days of the event or incident the member is complaining about. If something kept the member from filing their complaint (they were sick, we provided incorrect information, etc.), the member should let us know and we might be able to accept their complaint past 60 days Oral complaints should be directed to our member services department, and written complaints should be directed to our appeals and grievances department.
- We will address the member’s complaint as quickly as possible but no later than 30 days after receiving it. Sometimes we need additional information, or the member may wish to provide additional information. If that occurs, we may take an additional 14 days to respond to the member’s complaint. If the additional 14 days is taken, the member will receive a letter letting them know.
- If the member disagrees with us taking an extension (14 extra days) on a coverage decision or appeal, or because we dediced the member didn’t need a fast coverage decision or a fast appeal, the member may file a “fast” complaint. We will respond to the member within 24 hours of receiving the fast complain.
- If the member is dissatisfied with the response to the complaint, the member can request a review in writing. The member’s review request may include written information from the member or any other party of interest. The member must submit the review request within 60 calendar days of receiving the original resolution.
- Our appeals and grievances coordinators will direct the member’s review request to the appropriate committee, which will reconsider the written complaint and respond to the member in writing within 30 calendar days of receipt of the request for review. The plan can present the member’s case to the committee on the member’s behalf, or the member may choose to present the case to the committee.
For further information about the purpose and operations of the grievance procedure, members should contact:
Attn: Appeals and Grievances Department
Peoples Health
Three Lakeway Center
3838 N. Causeway Blvd., Suite 2500
Metairie, LA 70002
Seven days a week, 8 a.m. to 8 p.m.
1-800-222-8600 Toll-free
711 TTY
504-849-6959 Fax
Whether calling or writing, the member should contact member services right away.
The complaint must be made within 60 calendar days of the problem.
For quality of care problems, a member may also complain to KEPRO, the quality improvement organization for Louisiana.
Complaints concerning the quality of care received under Medicare, including care received during a hospital stay, may be acted upon by Peoples Health under the grievance process, by the independent review organization KEPRO, or by both. For example, if a member believes a pharmacist provided the incorrect dose of a prescription, the member may file a complaint with KEPRO in addition to or instead of a complaint filed under the Peoples Health grievance process. For any complaint filed with KEPRO, Peoples Health must cooperate with the agency in resolving the complaint. See a plan’s Evidence of Coverage for more information about KEPRO.
See a plan’s Evidence of Coverage for more information about how to file a quality of care grievance with the agency.
Members can contact KEPRO at:
KEPRO
5201 W. Kennedy Blvd., Suite 900
Tampa, FL 33609
1-888-315-0636 Toll-free
711 TTY
Website: www.keproqio.com