Health Right is dedicated to providing you with quality medical care and services. There may be a time, however, when you do not agree with a decision that has been made. If this happens, please let us know. We will solve the problem as quickly as possible.

FAST FACTS

• What should you do if you have a complaint with your doctor or Health Right Inc.
• How to make a complaint
• How to file a grievance
• What are my rights during the grievance process
• What is the expedited/grievance process

What should you do if you have a complaint with your doctor or with Health Right?
You may make a complaint. If you feel your problem is very serious and cannot be taken care of through a complaint, you may file a grievance without going through the complaint process.

How to Make a Complaint

1. Call or write your personal doctor?s office
2. Call Health Right Member Services (202-218-0380)
3. Write to: Health Right Inc.

Attn: Member Services
1101 14th Street, NW Suite 900
Washington, DC 20005

We at Health Right are very concerned about you, and want you to be happy. Our friendly staff is here to help. If you call Member Services, the staff will get the details of your problem and try to fix it as quickly as possible.

If your complaint cannot be cleared up right away, more details will be gathered from doctors, office staff, or other persons as needed. You will be contacted by our Member Services Department with the outcome of your complaint within 30 days, or within another agreed upon time frame. If you are not happy with the outcome, you may file a grievance.

How to File A Grievance

• If you have gone through the complaint process and you are not happy with the outcome, or if you feel that your problem will be better handled through a grievance rather than a complaint, you have the right to file a formal grievance. This formal grievance may be verbal or in writing. Either write to the address as listed on the previous page, or call Member Services at 202-218-0380.
• Once your grievance is received by Member Services, you will be sent a letter within 2 working days. This letter will:
• State the date your grievance was received by Health Right
• Tell you how to be active in the grievance process
• Confirm that your grievance will be resolved within 30 days unless more time is needed to gather information
• During the 30-day period, your grievance will be given to the Member Services Supervisor. This is the person who will get the details of your problem and take action to correct it. You will be sent a notice of the results of the Member Services Supervisor?s actions.
• If you are not happy with the results, you may appeal the decision. Simply request that the grievance be taken to the next level  to the Grievance Committee. Member Services can help you make this request. A letter will be sent to you within 30 days to let you know of the Grievance Committee?s final decision.

If you do not agree with the Grievance Committee?s final decision, you have the right to appeal to the Office of Administrative Hearings at the address listed below, or call the Helpline at 1-800-788-0342.

Your rights during the grievance process:

• You have the right to have someone help you through the grievance process. This person may be one of Health Right?s Member Services staff, or anyone else you choose.
• You also have the right, at any time during the grievance process, to contact the Office of Administrative Hearings through writing, in person, or to call the Helpline at 1-800-788-0342 if you need help. The address for the Office of Administrative Hearings is:

To file your complaints in person:

Office of Administrative Hearings
825 North Capitol Street, NE
Suite 4150
Washington, DC 20002-4210
Phone:? (202) 442-9094
Fax: (202) 442-4789

To mail your complaints:

Office of Administrative Hearings
P.O. Box 77718
Washington, DC 20013-8718

Expedited (Urgent) Grievance Process

If your grievance is urgent it will be resolved and the results will be given back to you within 1 hour. A grievance is considered urgent if harm could come to you if your grievance were to follow the standard time frame of the regular grievance procedure.

All appeals filed by members with HIV/AIDS, Mental Health or any other medical condition that need attention right away, will be resolved and communicated back to you within 72 hours of filing the grievance.