The purpose of Community Care Associates grievance and appeal process is to give Member’s (or their representative) an opportunity to resolve situations in which a Member is dissatisfied with services, benefits and/or Plan or Affiliated Providers’ policies and procedures. The following steps exist to resolve situations that cannot be resolved directly with an Affiliated Provider or through the Member Services Department.

Level 1

• You or your designated representative submits a written complaint to Member Services
• Your complaint is reviewed by the Manager of Member Services  
• You will receive a written notification of decision within five (5) business days 

Level 2

• If unsatisfied with the decision made at Level 1, you may appeal to the Chairman of the Grievance Committee
• You or your designated representative submits a written appeal to Grievance Committee Chairman
• An appeal must state the reason that you disagree with the Level 1 decision
• Once your appeal is received, a written notification  wil be sent notifying you of the next appeal level.