File a Grievance or Appeal

GRIEVANCE

Definition: A complaint, either oral or written, expressing dissatisfaction with service delivery or the quality of care furnished, regardless of whether remedial action is requested. Grievances may be between participants and the PACE organization or any other entity or individual through which the PACE organization provides services to the participant.

Who Can Submit a Grievance?

  • The participant

  • The participant's family member

  • The participant's designated representative

  • The participant's caregiver.

Grievance Process:

  • Filing: Grievance is communicated to a Buckeye PACE staff member

  • Acknowledgement: Buckeye PACE acknowledges receipt of the grievance

  • Investigation: Buckeye PACE will investigate the grievance

  • Resolution: Buckeye PACE will work to resolve the grievance and ensure that the griever is agreeable to the resolution.

  • Follow Up: All follow-up from the resolution of the concern will be completed.

How to File a Grievance:

Call toll free 330-236-8643

Download Grievance Form

APPEAL

Definition: A participant's action taken with respect to the PACE organization's noncoverage of, or nonpayment for, a service including denials, reductions, or termination of services.

Who Can Submit an Appeal?

  • The participant

  • The participant's designated representative

Appeal Process:

  • Filing: Request to appeal is communicated to a Buckeye PACE staff member

  • Acknowledgement: Buckeye PACE acknowledges receipt of the request to appeal

  • Review: Appeal is reviewed by an appropriate third party reviewer or committee

  • Notification: All parties involved in the appeal will receive appropriate written notification of the decision to approve or deny the appeal.

How to File an Appeal:

Call toll free 330-236-8643