Sunday, July 28, 2013


CarePlus members have 60 calendar days from the date of occurrence to file a formal grievance to the health plan.
Any Member who has a grievance against CarePlus or its providers for any matter may submit an oral or a written statement of the grievance to CarePlus.  A grievance form may be requested from the Member Services  or  the  Grievance  &  Appeals  Department.    The  oral  or  written  grievance  should  contain  the following:

a.  Member’s name, and identification number,
b.  Summary of occurrence,
c.  Description of the relief sought;
d.  The Member’s signature; and
e.  The date the grievance was signed.

The  written  statement  or  Grievance  Form  must  be  forwarded  to  the  CarePlus  Grievance  &  Appeals Department to the following address or fax number: 

11430 NW 20th Street, Suite 300
Doral, Florida 33172
Attention: Grievance & Appeals Department
Fax: (800) 956-4288

Grievances will be resolved in accordance with the Medicare Managed Care Manual mandated by CMS.

24 hours for expedited grievances.  Expedited grievances exist whenever:

  The  health  plan  extends  the  time  frame  to  make  an  organization/coverage  determination  or reconsideration or redetermination; or
  The health plan refuses to grant a request for an expedited organization/coverage determination, reconsideration or redetermination

30 calendar days for standard grievances.  Prompt appropriate action, including a full investigation of the grievance as expeditiously as the member’s case requires, based on the member’s health status, but no later than 30 calendar days from the date the oral written request is received, unless extended as permitted under 42 CFR 422.564 (e)(2).

CarePlus member will be referred to FMQAI, Florida’s Quality Improvement Organization (QIO), should the  grievance  be  relating  to  the  quality  of  care  or  service  from  the  plan  or  its  providers.    CarePlus member’s may also send inquiries or call FMQAI directly at the following:

5201 West Kennedy Blvd., Suite 900
Tampa, Florida 33609 
(800) 844-0795

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