How to File an Appeal or Grievance

Your satisfaction and health are important to us. We will work with you to try to find a solution to your issues. For any issue with Dignity Health Plans, please call Member Services first.

You have rights as a member of this plan and as someone who is getting Medicare. We will treat you with respect and take your concerns seriously. If you would like to obtain a report of the appeals, grievance, and exceptions filed with the plan, you may contact member services and request that information.

Appeal and Grievance information is contained within the Evidence of Coverage in Chapter 9. The Evidence of Coverage can be found by selecting the appropriate plan from the Members menu at the top of this page. If you need personal assistance with any issue, please contact Member Services. A representative will be glad to assist.

You can also get help and information from Medicare

For more information and help in handling a problem, you can also contact Medicare. Here are two ways to get information directly from Medicare:

• You can call 1-800-MEDICARE (1-800-633-4227) 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048.
• You can visit the Medicare.gov site to get help with Your Medicare Right.
• Submit a complaint to Medicare, click this link to be redirected to the Medicare Complaint Form.

Appointing a Representative

You may appoint someone to act on your behalf and serve as your representative on an appeal. You and your representative must sign the Appointment of Representative Form CMS 1696 and must be included with your appeal. The appointment is valid for one year unless revoked. A copy of this form must be included with any future appeals.

If you become incapacitated or of a legally incompetent status, a surrogate may be authorized by the court to act in accordance with State law to file an appeal on your behalf. In this case, an Appointment of Representative Form does not need to be executed. Instead, your surrogate must produce other appropriate legal papers supporting his or her status as your authorized representative when submitted an appeal on your behalf.

How to Obtain an Aggregate Number of Grievances, Appeals and Exceptions Filed with Dignity Health Plans.

To obtain an aggregate number of Dignity Health Plans grievances, appeals and exceptions, please call Member Services at 1-800-485-3793 from 8:00 a.m. to 8:00 p.m., Monday through Friday.

For help with complaints, grievances, and information requests, you can contact The Office of the Medicare Ombudsman (OMO).

Click here to file a complaint directly with CMS.

Last Updated on July 20, 2023