Grievances (Complaints)

Filing a Grievance

A grievance is any complaint you may have other than one that involves a Coverage Determination. You must file a grievance either orally or in writing no later than 60 days after the event or incident that led to the grievance. These are some examples of the types of problems that may lead you to file a grievance:

  • You feel that you are being encouraged to leave (disenroll from) AbilityCare.
  • There are problems with the service you receive.
  • You wait too long on the phone or in the pharmacy.
  • There are problems with the cleanliness or condition of pharmacy.
  • You disagree with our decision not to give you a "fast" Coverage Determination or Appeal.

You will receive a response within:

  • 24 hours if your grievance involves a refusal to give you a "fast" Coverage Determination or Appeal.
  • 30 calendar days for all other grievances. We may extend the timeline by up to 14 calendar days if you ask for an extension or we justify a need for additional information and the delay is in your best interest.

If you have a grievance, you may call Member Services.

You can also mail your grievance to:

South Country Health Alliance
Appeals & Grievances Department
6380 West Frontage Road
Medford, MN 55049

While we encourage you to contact South Country Health Alliance Member Services first when you have a grievance, you can also tell Medicare about your grievance directly by visiting the Medicare website (external link).

 

H5703_5772 Accepted 8/9/21

AbilityCare Member Materials
2022 MaterialsLast Updated
Enrollment FormPDF12/27/21
Evidence of CoveragePDF10/13/21
Annual Notice of ChangesPDF10/13/21
Summary of BenefitsPDF10/13/21
Pre-Enrollment ChecklistPDF10/25/21
List of Covered Drugs (Formulary)PDF5/1/22
Formulary UpdatesPDF5/1/22
Provider and Pharmacy DirectoryWeb PageSee link
Medicare Star RatingsPDF (EN)
PDF (SP)
10/19/21
LIS Premium Summary ChartPDF12/29/21
CMS Best Available Evidence CoverageWeb Page (external link)
Covered Diabetic Testing SuppliesPDF10/5/21

Last Updated on 12/02/2021 by Chris Gartner

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