a handbook for parents of children with autism spectrum disorders
a handbook for parents of children with autism spectrum disorders
a handbook for parents of children with autism spectrum disorders
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APPENDIX F:<br />
COMPLAINT PROCESS<br />
What is a complaint?<br />
A complaint is when you tell us you are unhappy <strong>with</strong> Community Care or a provider, or you do<br />
not agree <strong>with</strong> a decision made by Community Care.<br />
These are some examples <strong>of</strong> a complaint:<br />
• You are unhappy <strong>with</strong> the care you or your child are receiving.<br />
• You are unhappy that your child cannot get the service that you want <strong>for</strong> him or her because it is not<br />
a covered service.<br />
• You are unhappy that your child has not received services that have been approved <strong>for</strong> him or her.*<br />
* Community Care providers <strong>of</strong> service must provide services <strong>with</strong>in one hour <strong>for</strong> emergencies, <strong>with</strong>in<br />
24 hours <strong>for</strong> urgent situations, and <strong>with</strong>in seven days <strong>for</strong> routine appointments and specialty<br />
referrals. When a treatment plan is approved, your child should expect to receive services<br />
according to that treatment plan.<br />
What should I do if I have a complaint?<br />
First Level Complaint<br />
To file a complaint, call your Community Care Customer Service Representative and ask to speak to the<br />
Complaints and Grievances Department. Tell us your complaint and assistance will be provided.<br />
Or write down your complaint and mail it to the Community Care <strong>of</strong>fice in your area (See Appendix G).<br />
When should I file a First Level complaint?<br />
You must file a complaint <strong>with</strong>in 45 days <strong>of</strong> getting a letter telling you that:<br />
• Community Care has decided that your child cannot get a service because it is not a covered<br />
service.<br />
• Community Care will not pay a provider <strong>for</strong> a service that your child received.<br />
• Community Care did not decide a First Level complaint or grievance that you filed <strong>with</strong>in 30 days<br />
<strong>of</strong> when you filed it.<br />
You must file a complaint <strong>with</strong>in 45 days <strong>of</strong> the date you should have received a service if your<br />
provider did not give you the service. You may file all other complaints at any time.<br />
What happens after I file a First Level Complaint?<br />
Community Care will send you a letter to let you know we received your complaint. The letter will tell<br />
you about the First Level complaint process.<br />
You may ask Community Care to see the in<strong>for</strong>mation it has about your complaint. You may also send<br />
in<strong>for</strong>mation that may help <strong>with</strong> your complaint to the Community Care <strong>of</strong>fice in your area. You can<br />
also ask <strong>for</strong> assistance <strong>with</strong> your complaint by calling your customer services representative<br />
(See Appendix G).<br />
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