MEMBER HANDBOOK - Community Care Behavioral Health

36
You must send your request for an External Complaint Review in
writing to either:
• Pennsylvania Department of Health Bureau of Managed Care
Room 912 Health & Welfare Building, 625 Forster Street
Harrisburg, PA 17120
Phone: 1-888-466-2787; Fax: 1-717-705-0947
Relay Service: 1-800-654-5984 (For persons with hearing impairments)
-or-
• Pennsylvania Insurance Department Bureau of Consumer Services
1321 Strawberry Square, Harrisburg, PA 17120
Phone: 1-877-881-6388
If you send your request to the wrong department, it will be sent to the
correct department. The Pennsylvania Department of Health or the
Pennsylvania Insurance Department will get your complaint information
from Community Care. You may also send them any other information
that may help with the External Review of your complaint. You may
be represented by an attorney or another person during the External
Complaint Review. A decision letter will be sent to you after the
decision is made. This letter will tell you the reason(s) for the decision
and what you can do if you do not agree with the decision.
What should I do to continue getting services if Community
Care was authorizing services, but decided that those services
should now be reduced, changed, or stopped because they
are not covered services for me
If you file:
A First Level Complaint within 10 days of the date on the
letter from Community Care telling you of this decision...
A Second Level Complaint within 10 days of the date on the
letter from Community Care telling you of this decision...
An External Complaint within 10 days of the date on the
letter from Community Care telling you of this decision...
You will
continue
to receive
those
services until
a decision
is made
about your
complaint.
Customer Services 1-855-520-9715