Questions?
If you have questions about grievances, call UCare Customer Services from 8 a.m. to 8 p.m., seven days a week, at these phone numbers:
UCare for Seniors Customer Services: 612-676-3600 or 1-877-523-1515 (toll free).
UCare’s Minnesota Senior Health Options (MSHO) and UCare Connect Customer Services: 612-676-6868 or 1-866-280-7202 (toll free).
TTY: 612-676-6810 or 1-800-688-2534 (toll free).
Grievances
What is a grievance?
A grievance is any complaint other than one that involves a coverage determination (coverage or payment for Part D prescription drug benefits). You would file a grievance if you have any type of problem with UCare or one of our network pharmacies that does not relate to coverage for a prescription drug. For example, you would file a grievance if you have a problem with things such as waiting times when you fill a prescription, the way your Plan network pharmacist or others behave, being able to reach someone by phone or get the information you need, or the cleanliness or condition of a Plan network pharmacy.
When do I file a grievance?
You can file an oral or written grievance. Those processes are described below. You or your appointed representative may file a grievance. You must file a grievance no later than 60 days after the event or incident that caused the grievance. We can give you more time if you have a good reason for missing the deadline. We may extend the timeframe for resolving your oral or written grievance by up to 14 calendar days if you request the extension or if we justify a need for additional information and the delay is in your best interest. If we extend the deadline, we must immediately notify you in writing of the reason for the delay.
How do I file an oral grievance?
If you have an oral grievance, we encourage you to call UCare Customer Services from 8 a.m. to 8 p.m., seven days a week, at these phone numbers:
- UCare for Seniors and Customer Services: 612-676-3600 or 1-877-523-1515 (toll free).
- UCare’s Minnesota Senior Health Options (MSHO) and UCare Connect Customer Services: 612-676-6868 or 1-866-280-7202 (toll free).
- TTY: 612-676-6810 or 1-800-688-2534 (toll free).
You can file an oral grievance with a Customer Services representative. If we cannot resolve your oral grievance when we talk with you, we will look into the matter and call you with a response as quickly as your situation requires based on your health status, but no later than 10 calendar days from the date you called us. If you request a written response to your oral grievance, we will respond to you in writing. If you do not agree with our decision, we have a formal procedure to further review your grievance. We call this a written grievance.
How do I file a written grievance?
You can also send us your grievance in writing.
Mail your written grievance to:
UCare
Attn: Member Complaints, Appeals, and Grievances
P.O. Box 52
Minneapolis, MN 55440-0052
Or fax your written grievance to:
612-884-2021 or 1-866-283-8015 (toll free)
We will notify you within three business days that we received your written grievance. We will look into your concerns and gather information. We will send you a written response about your grievance as quickly as your situation requires based on your health status, but no later than 30 calendar days after receiving your written grievance. There are specific situations in which we will respond to your oral or written grievance within 24 hours. This is called an expedited (“fast”) grievance. You would file an expedited grievance if you disagree with our decision not to give you a “fast” initial decision (expedited coverage determination) or a “fast” (expedited) appeal.
What is a quality of care grievance?
If you are not happy with the quality of care you received under Medicare, you can file a quality of care grievance (complaint) with UCare or an organization called the Quality Improvement Organization (QIO), or both. The QIO is a group of doctors and other health care experts paid by the federal government to check on and help improve the care given to Medicare patients. They are not part of UCare or another health care organization. There is one QIO in each state. QIOs have different names, depending on which state they are in. In Minnesota, the QIO is called Stratis Health. The QIO in Wisconsin is MetaStar.
The doctors and other health experts in the QIO review certain types of grievances made by Medicare patients. An example of a possible quality of care grievance is if you believe your pharmacist gave you the incorrect dose of a prescription. Another example of a quality of care grievance is if you have been hospitalized and you think your hospital stay is ending too soon.
How do I make a quality of care grievance?
You must file a written quality of care grievance with the QIO. A member who files a quality of care grievance with a QIO is not required to file the grievance within a specific time period. You can also file a quality of care grievance with UCare following the oral or written grievance process above. To file a written qualify of care grievance with the QIO, send your grievance to the QIO in your state, or call them for more information.
Minnesota QIO:
Stratis Health
2901 Metro Drive
Suite 400
Bloomington, MN 55425-1525
Phone: 952-854-3306 or 1-800-444-3423 (toll free)
TTY: 711 or 1-877-627-3848 (toll free) (Minnesota Relay Service)
Wisconsin QIO:
MetaStar
2909 Landmark Place
Madison, WI 53713
Phone: 608-274-1940 or 1-800-362-2320 (toll free)
TTY: 711 or call 1-800-947-3529 (toll free) (Wisconsin Relay Service)