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Member Complaints and Grievances
Members of Atlantis Health Plan have the right to file a complaint or grievance regarding any aspect of the Plan or services provided by Atlantis or the Plan’s providers.
All disputes involving clinical decisions will be made by qualified clinical personnel. All notices of determination will include information about the basis of the decision and further appeal rights, if any.
Members have the right to designate a representative to file complaints and appeals on their behalf.
The Plan will not retaliate or take any discriminatory action against a Member because a complaint or appeal has been filed.
The MEMBER HANDBOOK provides a complete description of the Grievance Procedure that will be used to resolve disputes, to include:
Your right to file a grievance regarding any dispute:
· Your right to file a grievance orally when the dispute is about referrals or covered benefits;
· The toll-free telephone number which Members may use to file an oral grievance;
· The timeframes and circumstances for expedited and standard grievances;
Your right to appeal a grievance determination:
· The procedures for filing such an appeal;
· The timeframes and circumstances for expedited and standard appeals.
Please thoroughly review the Grievance Procedure section of the MEMBER HANDBOOK to understand your rights.