2024 Evidence of Coverage for UnitedHealthcare® Group Medicare Advantage PEBB Balance (PPO) Chapter 9: What to do if you have a problem or complaint (coverage decisions, appeals, complaints) 234 · Usually, calling Customer Service is the first step. If there is anything else you need to do, Customer Service will let you know. · If you do not wish to call (or you called and were not satisfied), you can put your complaint in writing and send it to us. If you put your complaint in writing, we will respond to your complaint in writing. · We must receive your complaint within 60 calendar days of the event or incident you are complaining about. If something kept you from filing your complaint (you were sick, we provided incorrect information, etc.) let us know and we might be able to accept your complaint past 60 days. We will address your complaint as quickly as possible but no later than 30 days after receiving it. Sometimes we need additional information, or you may wish to provide additional information. If that occurs, we may take an additional 14 days to respond to your complaint. If the additional 14 days is taken, you will receive a letter letting you know. If your complaint is because we took 14 extra days to respond to your request for a coverage determination or appeal or because we decided you didn’t need a fast coverage decision or a fast appeal, you can file a fast complaint. We will respond to you within 24 hours of receiving your complaint. The address and fax numbers for filing complaints are located in Chapter 2 under “How to contact us when you are making a complaint about your medical care” or for Part D prescription drug complaints “How to contact us when you are making a complaint about your Part D prescription drugs.” · The deadline for making a complaint is 60 calendar days from the time you had the problem you want to complain about. Step 2: We look into your complaint and give you our answer. · If possible, we will answer you right away. If you call us with a complaint, we may be able to give you an answer on the same phone call. · Most complaints are answered within 30 calendar days. If we need more information and the delay is in your best interest or if you ask for more time, we can take up to 14 more calendar days (44 calendar days total) to answer your complaint. If we decide to take extra days, we will tell you in writing. · If you are making a complaint because we denied your request for a “fast coverage decision” or a “fast appeal,” we will automatically give you a “fast complaint”. If you have a “fast complaint,” it means we will give you an answer within 24 hours. · If we do not agree with some or all of your complaint or don’t take responsibility for the problem you are complaining about, we will include our reasons in our response to you. Section 10.4 You can also make complaints about quality of care to the Quality Improvement Organization When your complaint is about quality of care, you also have two extra options: