Grievances and Member Feedback
SCAN Health Plan is committed to maintaining high levels of member satisfaction. We continuously strive to improve our services through member feedback. We encourage our members who require assistance with problem solving, to call our Member Services Department at 1-800-559-3500, 7:00 a.m. - 8:00 p.m., 7 days a week. TTY users should call 1-800-735-2929). Another avenue is to use the grievance process.
To find out more about the Grievance Process, please refer to your Evidence of Coverage (EOC). Click the link at the bottom of the page to find your EOC.
If you have a complaint, you or your representative may call the phone number for
Part C Grievances (for complaints about Part C medical care or services) and/or
Part D Grievances (for complaints about Part D drugs) listed in the EOC. We will try to resolve your complaint over the phone. If you ask for a written response, file a written grievance, or your complaint is related to quality of care, we will respond in writing to you.
If we cannot resolve your complaint over the phone, we have a formal procedure to review your complaints. We call this the grievance procedure.
As a SCAN member you may file the grievance yourself or appoint someone to do it for you. This person you appoint would be your authorized representative. You can appoint a relative, friend, advocate, doctor, attorney, or other person to act for you. If you already have someone authorized under state law to act for you, this person can file the grievance on your behalf.
The grievance must be submitted within 60 days of the event or incident. We must address your grievance as quickly as your case requires based on your health status, but no later than 30 days after receiving your complaint. We may extend the time frame by up to 14 days if you ask for the extension, or if we justify a need for additional information and the delay is in your best interest. If we deny your grievance in whole or in part, our written decision will explain why we denied it, and will tell you about any dispute resolution options you may have.
To find instructions on how to complete a grievance click here.
Grievance Form
When to Use the SCAN Grievance Report Form
You may use this form when you have a complaint such as:
- The quality of services that you receive
- Office waiting times
- Physician behavior
- Adequacy of facilities
- Involuntary disenrollment issues
- Any other areas of dissatisfaction that do not include coverage decisions
When Not to Use the SCAN Grievance Report Form
Do not use this form if your complaint is about a decision regarding the denial of services or payment. Instead, you will need to file an appeal. Please refer to your Evidence of Coverage (EOC) to find out how to file an appeal. Click the link below to find your EOC. Or call SCAN Member Services at 1-800-559-3500, 7:00 a.m. - 8:00 p.m., 7 days a week. TTY users should call 1-800-735-2929.
Evidence of Coverage
