Members Resources

Find tools, information, and other resources to help you get the most out of your benefits.

How to file a Grievance

What is a grievance?

A grievance is a type of complaint that does not involve payment or denial of services by ProCare Advantage. For example, you would file a grievance if:

  • You have a problem with things such as the quality of your care during a hospital stay;
  • You feel you are being encouraged to leave your plan;
  • Waiting times on the phone, at a network pharmacy, in the waiting room, or in the exam room;
  • Waiting too long for prescriptions to be filled;
  • The way your doctors, network pharmacists, or others behave;
  • Not being able to reach someone by phone or obtain the information you need; or
  • Lack of cleanliness or the condition of the office.
Who can file a grievance?

A grievance may be filed by any of the following:

  • You may file a grievance
  • Your authorized representative
Why file a grievance?

You are encouraged to use the grievance procedure when you have any type of complaint with ProCare Advantage, especially if such complaints result from misinformation, misunderstanding, or lack of information.

Where can a grievance be filed?

File a standard grievance over the phone or in writing to:

Phone: 1-844-206-3719 (TTY 711)

Fax: 1-833-610-2380

Mail:

ProCare Advantage
Appeals and Grievances Department
PO Box 5849
Glen Allen, VA 23058

File a complaint directly to Medicare by filling out the complaint form.

Can I expedite a grievance?

Yes, you may file an expedited grievance by calling: 

1-844-206-3719 (TTY 711)

Yes. If you disagree with ProCare Advantage’s decision to extend the timeframe or ProCare Advantage’s decision to process your expedited request as a standard request. In such cases, you may file an expedited grievance and receive a response within twenty-four (24) hours of receipt.