How to Make a Complaint (Grievance):
What is a grievance?
A grievance is a complaint you file with Granite Alliance. If you contact us with a complaint, we will file a grievance on your behalf.
Your complaint (or grievance) could be about any of the following types of items:
- You are unhappy with the quality of care you received
- You believe someone did not respect your privacy or shared your information
- You are unhappy with the customer service you received
- You experienced long wait times for the pharmacist or on the phone with Customer Service
- You are unhappy with the service received at or cleanliness of the pharmacy
- You believe the information we provided was hard to understand
- You believe we were not timely in our decision-making process
- Any other type of issue that may cause you concern
What is not considered a grievance?
If you are looking for approval on coverage of a medication, that would be considered a Coverage Determination. If you have already requested a Coverage Determination and it was denied, you are then able to submit an Appeal or a Redetermination. These processes themselves would not be considered a grievance.
How do I file a grievance?
You have the right to file a complaint up to 60 days after the event has occurred. There are several ways that you can contact us to file a grievance. You can also use these methods if you wish to request an aggregate number of grievances, appeals, and exceptions filed with Granite Alliance.
Generally, we recommend contacting Customer Service directly so a representative can work with you to resolve any concerns you may have. To file your grievance by phone, please call Customer Care at:1-855-586-2573 (TTY: 711), 24 hours a day, 7 days a week.
By Fax or Mail:
You may also put your complaint in writing and send it to us. In your complaint please include the following information:
- Your Name
- Your Address
- Your Phone Number
- Member ID
Details about the grievance
- Include the date that the incident occured along with an explanation
- Your Signature
- If your Appointed Representative is filing a grievance on your behalf, also include a completed Appointment of Representative Form. This form can be found here.
Send your complaint to the fax number or address below. We will respond to your complaint in writing.
Granite Alliance Grievances and Appeals Department P.O. Box 1382 Maryland Heights, MO 63043 Fax: 1-888-656-8099
What happens after I submit my grievance?
Once we receive your complaint, we will review and address it as quickly as possible. You will receive a response no later than 30 days after we have initially received your complaint. We may ask for an additional 14 days if we believe we need to gather more information to best address your concerns.
Once we have completed our review, you will be notified of the resolution either by telephone or in writing.
Where can I find additional information about the process?
Your Evidence of Coverage includes additional information about the Grievance process. The information can be found in Chapter 6. The Evidence of Coverage can be accessed from our Documents page.
You also have the option to file a complaint with CMS using the Medicare Complaint Form.