Problems or Complaints

Grievances and Appeals

For more information related to Grievances and Appeals:

Problems_Or_Complaints

Appointing a Representative – Instructions & Form

People who want to represent a member can be appointed or authorized by the member.

A member can authorize anyone (like a relative, friend, advocate, an attorney, or a doctor) to act as his or her representative and file an appeal on his or her behalf.

A representative (or surrogate) can also be authorized by the court or act on behalf of the member in accordance with State law to file an appeal for an enrollee. A surrogate could include, but is not limited to, a court appointed guardian, an individual who has Durable Power of Attorney, or a health care proxy, or a person designated under a health care consent statute.

How to authorize a representative:

  • The member must sign, date, and complete a representative form.
  • The person acting on behalf of the member must sign, date and complete the same form
  • Select the following link to view and print the representative form:  Appointment_of_Rep_Form.

If a member is incapacitated or legally incompetent a surrogate is not required to submit an Appointment of Representation Form. The surrogate will need to give Bridgeway copies of the legal papers supporting his or her status as the member’s authorized representative.Bridgeway requires a copy of the completed and signed Appointment of Representative Form to process an appeal filed by the member’s representative. The form will be valid during the entire appeal process.The Appointment of Representative Form is valid for one year from the date indicated on the form. A member can revoke the authorization at any time.

How to Obtain an Aggregate Number of Grievances, Appeals and Exceptions Filed with Bridgeway.

To obtain an aggregate number of Bridgeway grievances, appeals and exceptions, please call Member Services at (866) 475-3129 (TTY: (877) 613-2076) from 8:00 a.m. to 8:00 p.m., seven days a week.

Complaint

You can submit a grievance or complaint in writing. As a courtesy you can utilize the plan form to file the grievance or complaint. Please select the attachment below to download the plan grievance form:

Grievance_Form

Appeals

You must submit a standard appeal in writing. You have the option of submitted an expedited appeal in writing. As a courtesy you can utilize the plan form to file an appeal:

Appeal_Form

The Medicare Beneficiary Ombudsman

The Office of the Medicare Ombudsman (OMO) helps you with complaints, grievances, and information requests.  The Arizona Department of Economic Security (DES) is the Medicare Ombudsman for the State of Arizona.  DES can be contacted at 1-800-432-4040 or online at www.azdes.gov.

Filing a Complaint with the Centers for Medicare and Medicaid Services (CMS)

The following is a link to  access the CMS complaint form: 

https://www.medicare.gov/MedicareComplaintForm/home.aspx  (note selecting the link will take you away from the Bridgeway website). 

Para ver esta información en español chascar encendido el “español” abotone en la derecha superior de la página

Last Updated: 2/02/2012

 

Medicare