A Healthy CollaborationSM

Grievance Policy

Medicare Part D Grievances

It is Today’s Options policy to provide timely responses to Grievances.

Appeals and grievances: What to do if you have complaints
We encourage Today’s Options members to contact us with questions, concerns, or problems related to prescription benefits. Please call us at 888-875-0774 to discuss your concerns. Complaints and inquiries are grouped by type. Federal law guarantees Today’s Options members’ rights to make complaints regarding concerns or problems with any part of the plan. The Medicare program has helped set the rules about what’s needed to make a complaint, and what Today’s Options is required to do when we receive a complaint. If a complaint is filed, we must be fair in how we handle it. A Today’s Options member may not be disenrolled from Today’s Options or penalized in any way for making a complaint.

What are appeals and grievances?
Today’s Options members have the right to make a complaint regarding concerns or problems related to coverage or care. “Appeals” and “grievances” are the two different types of complaints that can be filed.

An “appeal” is the type of complaint a member can make when the member wants Today’s Options to reconsider and change a decision we have made about what prescription drug benefits are covered or what we will pay for a prescription drug. For example, if we refuse to cover or pay for a prescription drug a member thinks we should cover, an appeal can be filed. If Today’s Options refuses to provide a prescription drug the member thinks should be covered, the member can file an appeal. If Today’s Options reduces or cuts back on the prescription drugs a member has been receiving, the member can file an appeal. If the member thinks we are stopping prescription drug coverage too soon, the member can file an appeal.

A “grievance” is the type of complaint a member can make if the member has any other type of problem with Today’s Options or one of our network pharmacies. For example, a member should file a grievance if the member has problems with things such as waiting times when filling a prescription, the way the network pharmacist or others behave, being able to reach someone by phone or getting the needed information, or the cleanliness or condition of a network pharmacy.

A grievance is different from an appeal because usually it will not involve coverage or payment for Part D prescription drug benefits (concerns about our failure to cover or pay for a certain drug should be addressed through the appeals process discussed above).
Instead, the following types of problems might lead to you file a grievance:

  • If you feel that you are being encouraged to disenroll from Today’s Options
  • Problems with the quality of customer service you receive
  • Problems with how long you have to spend waiting on the phone or in the pharmacy
  • Disrespectful or rude behavior by pharmacists or other staff
  • Problems with the cleanliness or condition of the pharmacy
  • If you disagree with our decision not to expedite your request for an expedited coverage determination or redetermination
  • You believe our notices and other written materials are difficult to understand
  • Failure of Today’s Options to make a decision within the required time frame
  • Failure of Today’s Options to forward your case to the independent review entity if we do not make a decision within the required time frame

The Grievance Process
A grievance is different from an appeal because usually it will not involve issues regarding coverage or payment for Part D prescription drug benefits. Concerns about our failure to cover or pay for a certain drug should be addressed through the appeals process.

Filing a grievance with Today’s Options
If you have a grievance, we encourage you to first call Member Services at 1- 866-568-8921 (TTY/TDD users call 1-800-958-2692), 8 AM to 8 PM, 7 days a week..

We will try to resolve any complaint that you might have over the phone. If you request a written response to your phone complaint, we will respond to you in writing. If we cannot resolve your complaint over the phone, we have a formal procedure to review your complaints. We call this the Today’s Options Grievance Process.

You may file a grievance by telephone, fax, or through the mail, no later than 60 days after the event that caused the grievance. When you file a written grievance you will receive a written confirmation that your grievance was received. All written grievances will be responded to in writing no later than 30 days from the date that the grievance was received by Today’s Options.

If your grievance involves a refusal by Today’s Options to grant your request for an expedited coverage determination or an expedited redetermination, and you have not yet received the medication that is in dispute, you may file an expedited or “fast” grievance. To file a “fast” grievance, please contact the Member Services at 1-866-684-5353 (TTY/TDD users call 1-866-684-5351) 8 AM to 8 PM, 7 days a week, or fax your written complaint to 1-866-684-5378. In this case, you will receive a response within 24 hours.

Please do not file a “fast” grievance by mail, as we cannot guarantee a response within 24 hours.

In certain circumstances, Today’s Options may extend the 30-day response time by 14 days. We may also extend the timeframe if you request us to do so. Today’s Options may also extend the timeframe if we are in need of additional information. In this case, we only extend the timeframe if the delay is in your best interest and you will receive a letter notifying you of the extension.

Community CCRx Part D Grievances (about your Part D prescription drugs)

CALL: 1-866-316-6049. Calls to this number are free.
TTY/TDD 1-866-684-5351. This number requires special telephone equipment.
Calls to this number are free.

FAX: 1-866-868-0858

WRITE: Community CCRx
Grievances
P.O. Box 5205
Rennselaer, NY 12144-5205

M0018_PFFSWebv5_0209 Pending CMS Approval Last updated: 4/1/2022

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