Grievances and appeals

If a member has a concern or question regarding the health care services he/she has received, he/she should contact the Member Services department at the toll-free number on the back of their identification card. If the Member Service representative does not resolve the problem to the member's satisfaction, he/she has the right to file a grievance.

What is a grievance?

A grievance expresses dissatisfaction about any matter related to the services offered by Keystone First VIP Choice (HMO SNP). A grievance may be filed about such things as the quality of the care the member receives from a Keystone First VIP Choice provider, rudeness from a Keystone First VIP Choice employee or a provider's employee, a lack of respect for their rights by Keystone First VIP Choice or any service or item that did not meet accepted standards for health care during a course of treatment.

How does a member file a grievance?

To file a grievance, the member, or the member's physician or other representative, may call Member Services at 1-800-450-1166, TDD/TTY 711, or write to:

Keystone First VIP Choice
Attn: Member Appeals, Grievances and Complaints
P.O. Box 80109
London, KY 40742-0109

Additional grievances and appeals information can be found in the Provider Manual (PDF).