Magellan Health

For Members

Complaints & Grievances

How to file a complaint, grievance and appeal

Magellan has developed a quick how-to-guide for service recipients and family members on how to file a complaint, grievance and appeal. The guide is easy to navigate and fits your pocket or wallet, and is available in English or Spanish.

What can I do if I have a complaint about my care?

If you are not happy with your care, try to solve any issues at the lowest possible level by talking with your provider or PNO. You may also call Magellan of Arizona at (800) 564-5465 or TTY (800) 424-9831.

What is a formal complaint, and how do I make one?

A formal complaint is when you are not happy with any aspect of your care. Reasons for complaints could include such things as:

  • The quality of care or services you received
  • A disagreement with a denial to process an appeal as expedited
  • The failure of a provider to respect a person's rights
  • A provider or employee of a provider being rude to you

Some issues require you to file an appeal instead of a formal complaint. This process is described in the appeals section below. The issues that require an appeal include:

  • The denial or limited approval of a service asked for by your provider
  • The reduction, suspension or termination of a service that was approved in the past
  • The denial, in whole or part, of payment for a service
  • The failure to provide services in a timely manner
  • The failure to act within the timeframe for resolving an appeal or complaint
  • If you live in a rural area, the denial of a request for services outside of the provider network when services are not available within the provider network

Formal complaints can be made either orally or in writing to:

Magellan Health Services of Arizona
P. O. Box 68110
Phoenix, AZ 85082-8110
(800) 564-5465 or (800) 424-9831 (TTY)

You will receive acknowledgment of receipt of your complaint. Complaints fielded orally are considered acknowledged at the time of filing. If you file your complaint in writing, you will receive a written acknowledgment within five working days. Magellan makes every effort to resolve complaints as quickly possible and in no longer than 90 days. If you file your complaint in writing, you will receive written notification of resolution.

What is an appeal, and how do I file an appeal?

An appeal is a formal request to review an action or decision related to your behavioral health services.

There are three types of appeals depending on what is being appealed and who is filing the appeal. The three types of appeals are:

  1. Appeals for Title XIX/XXI AHCCCS-eligible persons
  2. Appeals for persons determined to have a serious mental illness
  3. Appeals for persons who are not seriously mentally ill and non-Title XIX/XXI eligible

How do I file an appeal?

Appeals can be filed orally or in writing with Magellan within 60 days of receiving a Notice of Action. A Notice of Action is a written document that informs you of a change in your services. An expedited appeal will be processed sooner than a standard appeal based on the urgency of the behavioral health needs of the person filing the appeal. Contact Magellan Member Services at (800) 564-5465 or TTY (800) 424-9831, or your provider to see if your appeal will be expedited.

You can file an appeal or, with your written permission, your legal or authorized representative, including a provider, can file an appeal on your behalf. You can also get help with filing an appeal by yourself.

To file an appeal orally or for assistance with filing a written appeal, contact:

Magellan Health Services
P.O. Box 68110
Phoenix, AZ 85082-8110
(800) 564-5465 or (800) 424-9831 (TTY)

You will get written notice that your appeal was received within five working days. If your appeal needs to be expedited, you will get notice that your appeal was received within one working day.

Medicare Part D Exceptions and Appeals

Every Medicare Part D plan must have an exceptions and appeals process. If you have Medicare Part D Prescription Drug coverage and you file an exception or appeal, you may be able to get a prescription drug that is normally not covered by your Part D plan. Contact your Part D plan for help in filing an exception or appeal regarding your prescription drug coverage.

What is a grievance/request for investigation for persons determined to have a serious mental illness, and how can I file one?

The grievance/request for investigation process applies only to adult persons who have been determined to have a serious mental illness. You can file a grievance/request for investigation if you feel:

  • Your rights have been violated
  • You have been abused or mistreated by staff of a provider
  • You have been subjected to a dangerous, illegal or inhumane treatment environment

You have 12 months from the time that the rights violation happened to file a grievance/request for investigation. You may file a grievance/request for investigation orally or in writing. Grievance/request for investigation forms are available by:

  • Calling Magellan of Arizona at (800) 564-5465, TTY (800) 424-9831
  • Online at www.MagellanofAZ.com, HERE.
  • From your behavioral health provider or PNO

You may ask staff for help in filing your grievance.

To make your oral or written grievance/request for investigation, contact:

Magellan Health Services
P.O. Box 68110
Phoenix, AZ 85082-8110
(800) 564-5465 or (800) 424-9831 (TTY)

Any grievance concerning physical abuse, sexual abuse or a person's death must be submitted to the Arizona Department of Health Services Division of Behavioral Health Services (ADHS/DBHS). To file an oral or written grievance concerning physical abuse, sexual abuse or a person's death, contact:

ADHS/DBHS Office of Grievance and Appeals
150 N. 18th Ave., Ste. 210
Phoenix, AZ 85007
(800) 421-2124 or (602) 364-4575

ADHS/DBHS or Magellan will send you a letter within seven days of getting your grievance/request for investigation form. This letter will tell you how your grievance/request for investigation will be handled.

If there will be an investigation, the letter will tell you the name of the investigator. The investigator will contact you to hear more about your grievance/request for investigation. The investigator will then contact the person you feel was responsible for the rights violation. The investigator will also gather any other information he/she needs to determine if your rights were violated.

Within 35 days of an investigator being assigned to investigate, unless an extension has been granted, you will get a written decision of the findings, conclusions and recommendations of the investigation. You will also be told of your right to appeal if you do not agree with the conclusions of the investigation.

If you file a grievance/request for investigation, the quality of your care will not suffer.

Return to Top

Are You in Crisis?

If you are in crisis, call the Crisis Line at (800) 631-1314, TTY (800) 327-9254. For emergencies, always call 9-1-1

Confidentiality

Everyone has the right to have personal information kept private. We work hard to protect your privacy. Read more.

Contact Information

Mercy Maricopa Integrated Care (Mercy Maricopa) is now the Regional Behavioral Health Authority (RBHA) serving members in the Maricopa County Region. For questions regarding your services, please call 1-800-564-5465 or TDD/TTY 711.

** To file a grievance or appeal for services provided on or before March 31, 2014 please call Magellan Health Services 602-652-5907, x8590