Complaint/Grievance Process

IF YOU HAVE A COMPLAINT OR GRIEVANCE

HealthChoices Mental Health Services:

The Bucks County Behavioral Health System and Magellan Behavioral Health of Pennsylvania, Inc. have joined together to provide a behavioral health care program. This program is for people in Bucks County who are enrolled in the HealthChoices Program and who need help with mental health, substance abuse, or co-occurring issues.

You may file a complaint with us, if you feel your privacy rights have been violated. To file a complaint, either contact us by phone or in writing. The telephone number and address is listed below. You may also complain to the US Secretary of Health and Human Services. You will not receive a negative reaction from us because you file a complaint.

A complaint is when you tell us you are unhappy with Magellan or your provider or you do not agree with a decision made by Magellan. These are some examples of a complaint:

  • You are unhappy with the care you are getting.
  • You are unhappy that you cannot get the service you want because it is not a covered service.
  • You are unhappy that you have not received services that you have been approved to get. (Magellan’s providers must provide services within one hour for emergencies, within 24 hours for urgent situations, and within seven days for routine appointments and specialty referrals. If a treatment plan is approved, services must be provided according to the prescribed treatment plan.)

To file a complaint, you can:

       Call Magellan at 1-877-769-9784.
Or,
       Write down your complaint and send it to:
       Magellan
       P.O. Box 1261
       Newtown, PA 18940-0873

A grievance is what you file when you do not agree with Magellan’s decision that a service that you or your provider asked for is not medically necessary. You can file a grievance if Magellan does any one of these things:

  • Denies a service,
  • Approves less than what you asked for, or
  • Approves a different service from the one that was asked for.

If Magellan does not completely approve a service for you, we will tell you in a letter. The letter will tell you how to file a first level grievance. You have 45 days from the date you receive this letter to file a grievance.

To file a grievance, you can:

       Call Magellan at 1-877-769-9784
Or,
       Write down your grievance and send it to:
       Magellan
       P.O. Box 1261
       Newtown, PA 18940-0873
Or,
       Your provider can file a grievance for you, if you give the provider your consent in writing.

NOTE: If your provider files a grievance for you, you cannot file a separate grievance on your own.

Online Resources
Please go to www.MagellanHealth.com/member for detailed information on Magellan’s Complaint/Grievance procedure as well as other benefit information about your HealthChoices program with Magellan and provider listings. First time users, click on New User and use your county toll-free number, 1-877-769-9784, as your program number.

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COUNTY MENTAL HEALTH SERVICES

If you have a complaint or grievance with the mental health services you are receiving please contact:

MH Deputy Administrator
Department of Mental Health/Development Programs
215-442-0760

DEVELOPMENTAL PROGRAMS SERVICES

If you have a complaint or grievance with the Development Programs you are receiving please contact:

MR Deputy Administrator
Department of Mental Health/Development Programs
215-444-2847

EARLY INTERVENTION SERVICES

If you have a complaint or grievance with the early intervention services you are receiving please contact:

EI Director
Department of Mental Health/Development Programs
215-444-2847

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ALCOHOL AND OTHER DRUG TREATMENT – PRIVATE INSURANCE

Please contact your insurance company to request a copy of their complaint and/or grievance policy.

If you are not satisfied after you have followed this process you can:

  • Get information on how to make a complaint and to obtain an online or downloadable complaint form from the Pennsylvania Insurance Department.
  • Call the toll free Automated Consumer Line at 1-877-881-6388.
  • Contact the Philadelphia Regional Office of the Pennsylvania Insurance Department:

    Philadelphia Regional Office
    Room 1701 State Office Building
    1400 Spring Garden Street
    Philadelphia, PA  19030
    215-560-2630
    215-560-2648 (fax)
    TTY/TDD 215-560-2471

For information on your insurance rights in Pennsylvania regarding coverage for alcohol or other drug treatment, please click here.

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ALCOHOL AND OTHER DRUG TREATMENT - PUBLIC FUNDS

Bucks County wants you to have the best possible drug and alcohol treatment with the public funds that they manage. Please tell us if we can make these services better. Please also call the Bucks County Drug and Alcohol Commission, Inc. (BCDAC) if you have a complaint. You can call us Monday to Friday if you have a problem. You can also call your BCDAC case manager if you have one.

215-773-9313 or 215-788-8172
8:30 a.m. to 4:30 p.m.

We will not stop county funding of your treatment while we look into your complaint or your grievance. We will let you know how things are going every step of the way.

Complaints

You can make a complaint to us at any time. You can complain if you feel your counselor did not treat you right. You can complain if you feel your counselor did a wrong thing. To make a complaint please call, e-mail or write us.

Complaint and Grievance Department
Bucks County Drug & Alcohol Commission, Inc.
600 Louis Dr., Suite 102-A
Warminster, PA  18974
215-773-9313
dnacomplaints@co.bucks.pa.us

Anyone can help you make a complaint in writing. One of our staff members can also help you write a complaint. If you need someone to speak for you, please let us know. We will work to address your complaint quickly.   You can also read about filing a complaint in our Bucks County Client Handbook. If you do not have a Client Handbook, please call and ask for one.

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Grievances

You may file a grievance if you are not happy with your treatment. You may be unhappy because the county (BCDAC) will not pay for your substance abuse treatment; or you may want more treatment than we will pay for; or you may not agree with the type of treatment you are getting; or you may not agree with the amount of money you are being charged for treatment as co-pay. You may also feel that you were not ready for your drug and alcohol case management to end. You can also file a grievance if you are not happy with the way you were treated by your counselor or if you feel your human rights or your civil rights were violated.

The information about the grievance you make will not be shared with anyone. You can have a copy of the details of how your grievance was resolved.

There are three levels of grievance:

Level One:

You may make a grievance over the phone, in person, or in writing to our Grievance and Complaint Department. You do not need to use a special form. Just tell us your concern and let us know that this is a grievance. Explain the problem, and give us all of the facts. Tell us how you want the problem solved. We will get back to you, in writing, within seven (7) working days.

Level Two:

If you are not happy with what we decide at the first level grievance, you can ask for a second level grievance. You will need to let us know of this appeal within ten (10) working days from when you hear our decision. You can let us know of this by phone; or you can call us or write us. We will get back to you in seven (7) working days. Our clinical management team will hear your grievance.

Level Three:

If you are not happy with the decision made at the second level grievance, you can ask for a third level grievance. You can let us know of your choice to appeal by phone or letter within seven (7) working days from when you hear our decision. A group of at least five people who are not connected with our agency will review your grievance. You must sign a consent form so that your information can be shared with the people reviewing your request. You have the right to get all paperwork about the appeal; also, you, or someone you choose, will be allowed to be involved in the appeal process. You will hear from us in writing in seven (7) working days. Please call, e-mail or send this appeal to:

Complaint and Grievance Department
Bucks County Drug & Alcohol Commission, Inc.
600 Louis Dr., Suite 102-A
Warminster, PA  18974
Phone 215-773-9313
dnacomplaints@co.bucks.pa.us

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