Members Resources
Find tools, information, and other resources to help you get the most out of your benefits.
How to file a Grievance
What is a grievance?
A grievance is a type of complaint that does not involve payment or denial of services by PruittHealth Premier. For example, you would file a grievance if:
- You have a problem with things such as the quality of your care during a hospital stay;
- You feel you are being encouraged to leave your plan;
- Waiting times on the phone, at a network pharmacy, in the waiting room, or in the exam room;
- Waiting too long for prescriptions to be filled;
- The way your doctors, network pharmacists, or others behave;
- Not being able to reach someone by phone or obtain the information you need; or
- Lack of cleanliness or the condition of the office.
Who can file a grievance?
A grievance may be filed by any of the following:
- You may file a grievance
- Your authorized representative
Why file a grievance?
You are encouraged to use the grievance procedure when you have any type of complaint with PruittHealth Premier, especially if such complaints result from misinformation, misunderstanding, or lack of information.
Where can a grievance be filed?
You may file a standard grievance over the phone or in writing to:
Georgia: 1-855-855-0668 (TTY 711)
North Carolina and South Carolina: 1-855-855-0759 (TTY 711)
Fax: 1-833-610-2380
Mail:
PruittHealth Premier
Appeals and Grievances Department
PO Box 2190
Glen Allen, VA 23058
If you would like you can file a complaint directly to Medicare by filling out the complaint form at https://www.medicare.gov/MedicareComplaintForm/home.aspx.
Can I expedite a grievance?
Yes, you may file an expedited grievance by calling:
Georgia: 1-855-855-0668 (TTY 711)
North Carolina and South Carolina: 1-855-855-0759 (TTY 711)
If you disagree with PruittHealth Premier’s decision to extend the timeframe or PruittHealth Premier’s decision to process your expedited request as a standard request. In such cases, you may file an expedited grievance and receive a response within twenty-four (24) hours of receipt.