MEMBER HANDBOOK - Community Care Behavioral Health

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44 Persons Whose Primary Language is Not English If you ask for language interpreter services, Community Care will provide the services at no cost to you. Si Ud. Necesita la versión en Español de este manual, por favor solicite una a este teléfono 1-866-229-3187. Persons with Disabilities and Special Needs If needed, Community Care will provide persons with disabilities with the following help in presenting complaints or grievances at no cost. • Providing sign language interpreters. • Providing information submitted by Community Care at the complaint or grievance review in an alternative format. The alternative format version will be given to you before the review. • Providing someone to help photocopy and present information at your complaint or grievance review. For some issues, you can request a Fair Hearing from the Pennsylvania Department of Public Welfare in addition to or instead of filing a Complaint or Grievance with Community Care. In some cases, you can request a Fair Hearing at any time. What Is a Fair Hearing In some cases, you or your representative can ask the Department of Public Welfare (DPW) to hold a hearing because you are unhappy about, or do not agree with, something that Community Care did or did not do. These hearings are called DPW Fair Hearings. You can ask for a Fair Hearing when you file a complaint or grievance or after Community Care decides your First or Second Level Complaint or Grievance. Customer Services 1-855-520-9715
45 What kinds of things can I request a Fair Hearing for and when do I have to ask for a Fair Hearing If you are unhappy because... You must ask for a Fair Hearing... Community Care decided to deny a service because it is not a covered service. Community Care decided not to pay a provider for a service you received AND the provider can bill you for the service. Community Care did not decide your First Level Complaint or Grievance within 30 days of when you filed it. Community Care decided to deny, decrease, or approve a service different than the one that your provider requested because it was not medically necessary. A Community Care provider did not give you a service by the time you should have received it. Within 30 days of the date on the letter from Community Care telling you of this decision OR within 30 days of the date on the letter from Community Care acknowledging or telling you its decision after you filed a complaint about this issue. Within 30 days of the date on the letter from Community Care telling you that we did not make a decision about your complaint or grievance within the time frame we were supposed to follow. Within 30 days of the date on the letter from Community Care telling you of this decision OR within 30 days of the date on the letter from Community Care acknowledging or telling you its decision after you filed a grievance about this issue. Within 30 days of the date on the letter from Community Care telling you its decision after you filed a complaint about this issue. Customer Services 1-855-520-9715
Page 1 and 2: Behavioral Health Services MEMBER H
Page 3 and 4: Welcome to Community Care! Customer
Page 5 and 6: 3 Section 1 About Community Care Pa
Page 7 and 8: 5 Community Care Community Care is
Page 9 and 10: 7 Emergency Help If you have a beha
Page 11 and 12: 9 Section 2 Behavioral Health Servi
Page 13 and 14: 11 Covered Services Community Care
Page 15 and 16: 13 Payment for Treatment We pay you
Page 17 and 18: 15 Section 3 Getting Help Page How
Page 19 and 20: 17 Getting Help Call us when: • Y
Page 21 and 22: 19 If You Have an Urgent Need for C
Page 23 and 24: 21 Section 4 Your Rights and Respon
Page 25 and 26: 23 As required by the federal law a
Page 27 and 28: 25 C. To be treated in a considerat
Page 29 and 30: 27 D. Carry your ACCESS, Physical H
Page 31 and 32: 29 Section 5 Complaints, Grievances
Page 33 and 34: 31 What is a Complaint A complaint
Page 35 and 36: 33 If you file a complaint because
Page 37 and 38: 35 • The committee will make a de
Page 39 and 40: 37 What is a Grievance A grievance
Page 41 and 42: 39 What if I do not like Community
Page 43 and 44: 41 You will receive a decision lett
Page 45: 43 who does not work for Community
Page 49 and 50: 47 You may come to the Fair Hearing
Page 51 and 52: 49 Section 6 Your Advocate Page Wha
Page 53 and 54: 51 An Advocate An advocate is a per
Page 55 and 56: 53 Section 7 Consumer/Family Satisf
Page 57 and 58: 55 Consumer/Family Satisfaction Tea
Page 59 and 60: 57 Section 8 How To Get More Involv
Page 61 and 62: 59 How can I get more involved We w
Page 63 and 64: 61 Section 9 Important Contact Info
Page 65 and 66: 63 Call Community Care Customer Ser
Page 67 and 68: 65 Section 10 Definitions Customer
Page 69 and 70: 67 HealthChoices HMO A Health Maint
Page 71 and 72: COMMUNITY CARE'S MISSION... To impr

MEMBER HANDBOOK - Community Care Behavioral Health

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