What is a Complaint?
A Complaint is when you tell Magellan you are unhappy with Magellan or your provider or do not agree with a decision by Magellan.
What is a Grievance?
When Magellan denies, decreases, or approves a service different than the service you requested because it is not medically necessary, you will get a notice telling you Magellan’s decision. A Grievance is when you tell Magellan you disagree with Magellan’s decision.
Some things you may complain about:
- You are unhappy with the care you are getting.
- You cannot get the service you want because it is not a covered service.
- You have not received services that Magellan has approved.
Resources
Click here and go to page 41 or 46 for more information.
Complaint and Grievance Committee Opportunities
At certain levels of Magellan’s Complaint and Grievance procedures, the review committee making the decision includes a Member (or for reviews involving children, a guardian of a Member). This perspective is extremely valuable in understanding each Member’s concerns and helps shape positive outcomes.
If you or someone you know is interested in learning more about this opportunity to serve on this committee please go here. Questions may be directed to John Bottger, Appeals and Comments Manager, at 215-504-3900.
Complaints & Grievances Committee Flyer
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