Chartered is dedicated to providing you and your family with quality medical care and service. However, there may be a time when you do not agree with a decision that has been made or are unhappy with our services. If this happens, please let us know. All member concerns are investigated and resolved as soon as possible by a Chartered Staff person.

How to file a complaint, appeal or grievance

	You, your representative, or provider may call us at 202-408-4720 or toll free at 1-800-408-7511, a member services representative will document your concern and refer it to a Grievance Coordinator for investigation; or
	You may write us with your concern at:

If your concern is not resolved to your liking then you may file a grievance. You can file the grievance with Chartered or with the Office of Administrative Hearings (see contact information below).

Whenever Chartered makes a decision to deny, reduce, terminate, or delay authorization of a requested covered service or deny payment, the following must occur:

	A written notice is sent to you within five (5) business days of the decision.
	You and the provider who is caring for you have sixty (60) days from the date Chartered mails this notice to file a complaint or grievance with Chartered; or
	Request a fair hearing through the Office of Administrative Hearings at:

Chartered will make a final decision within thirty (30) business days from the date we receive the grievance and all necessary information.

Urgent Medical Conditions

Grievances involving urgent medical condition will be decided within one (1) hour. The decision will be in writing and include:

	The reason(s) for the decision;
	The basis for the decision;
	Your appeal rights and the time frames for filing an appeal.

Should you disagree with Chartered’s decision, you or your provider has thirty (30) days to file an appeal in writing.

YOUR RIGHTS:

	To immediately request a fair hearing through the Office of Administrative Hearings;
	To receive information on how to obtain a Fair Hearing;
	To represent yourself or be represented by your family or caregiver, legal counsel or other representative;
	To continue to receive your benefits and services from Chartered while the final decision is pending;
	To a fair hearing whether or not the member uses the grievance procedures maintained by Chartered;
	To have assistance with your special health care needs; and
	To have these rights presented in a manner easily understood by you and in the language of your choosing

YOUR APPEAL RIGHTS

	You have the right to file a complaint or grievance with Chartered and the right to request a fair Hearing at the Office of Administrative Hearings at any time;
	You have a the right to appear in person in front of Chartered’s staff;
	You have a right to have a representative involved in the process;
	You have the right to an Ombudsman and Chartered will help you contact one;
	You have the right to get free copies of the documents and guidelines used to make the decision, including your medical records.

WRITTEN NOTICE OF RECEIPT

While your appeal is pending, your benefits will continue without change until one of the following happens:

	The grievance is resolved;
	You withdraw the appeal;
	You do not request a Fair Hearing within ten (10) days of Chartered’s decision;
	The Office of Administrative Hearings decides against you;
	The time period or service has been met.

If you want help with any part of the complaint, appeal or grievance process, including help filing your concern or responding to any part of the investigation and resolution process, please call Chartered’s Customer Service department at 202-408-4720 or toll free at 1-800-408-7511. A Customer Service representative will answer your questions, help with paper work or explain how the complaint, grievance and appeal processes work. If you ask, Chartered will also help you file your concern with the Office of Administrative Hearings.

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