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 LifeWorks Advantage or Contracting Medical Provider. 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 are too long;
- 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 your doctor’s 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 (other than an appeal) with LifeWorks Advantage or a Contracting Medical Provider, especially if such complaints result from misinformation, misunderstanding, or lack of information.
When can a grievance be filed?
You may file a grievance as soon as the incident occurs but no later than sixty (60) calendar days of the date of the incident.
Note: The sixty (60) day limit may be extended for good cause. Include in your written request the reason why you could not file within the sixty (60) day time frame.
Where can a grievance be filed?
File a standard grievance over the phone or in writing to:
Phone: 1-844-854-6883 (TTY 711)
Mail:
LifeWorks Advantage
Appeals and Grievances Department
PO Box 2190
Glen Allen, VA 23058
Fax: 1-833-610-2380
File a complaint directly to Medicare by filling out the complaint form.
Can I expedite a grievance?
Yes, you may file an expedited grievance by calling: 1-844-854-6883 (TTY 711).
If you disagree with LifeWorks Advantage’s decision to extend the timeframe or LifeWorks Advantage’s decision to process your expedited request as a standard request, you may file an expedited grievance and receive a response within twenty-four (24) hours of receipt.
What happens next?
We will review your Grievance and provide a resolution as expeditiously as possible but no later than thirty (30) days from your initial request. If additional information is needed and the delay is in your best interest, or if you ask for more time, we can take up to 14 more days to respond to your grievance.
