Learn when and how to file a complaint (also called a grievance)
What’s a grievance?
If you are not satisfied with the care or service you receive, you can make a complaint at any time. This is formally called “filing a grievance.” This includes problems related to quality of care, waiting times, and the customer service you receive.
Who can file a grievance?
You or your appointed legal representative may make a complaint. You can name a relative, friend, attorney, doctor, or someone else to act for you. Others may already be authorized under state law to act for you. In order to appoint a legal representative, the proper documentation must be submitted to us. Examples of appropriate representation documents may include, but are not limited to, a durable power of attorney, a health care proxy, an appointment of guardianship, or other legally recognized forms of appointment. You may also download and complete the appointment of representative form below. To obtain the total number of our grievances, appeals, or exceptions, please contact us.
Appointment of Representative form
When do I file a grievance?
It is best to file a grievance as soon as you experience a problem. The grievance must be made within 60 calendar days after you had the problem you want to complain about.
How do I file a grievance?
1-866-393-5366 or 305-559-5366 (TTY 711).
We’re here from 8:00 a.m. to 8:00 p.m., seven days a week, from October 1 through March 31 and Monday to Friday, the rest of the year.
Leon Medical Centers Health Plans
PO Box 66-9440
Miami, Florida 33166
When will I hear back?
If you call us with a complaint, we may be able to resolve it for you on the same phone call. Most grievances are resolved within 30 days. If we need more information and the delay is in your best interest, or if you ask for more time, we can take up to 14 more days (44 days total) to respond to your grievance. Upon completion of our review, we will notify you by phone or in writing.
If we do not agree with some or all of your complaint or don’t take responsibility for the problem you are complaining about, we will let you know. Our response will include our reasons for this answer. We must respond whether we agree with the complaint or not.
If you are making a complaint because we denied your request for a “fast coverage decision” or a “fast appeal,” we will automatically give you a “fast complaint.” If you have a “fast complaint,” it means we will give you an answer within 24 hours.
To submit a complaint to Medicare, complete the Medicare Complaint Form