Grievances

MCO Grievance Process

• What is a managed care grievance?

  A managed care grievance is an expression of dissatisfaction about any matter other than an adverse decision or an action.

  Possible subjects or examples of a KanCare Grievance might be:

  • You are unhappy with the quality of your care or services provided.
  • Poor behavioral by an employee of the MCO or their provider.
  • The failure to respect a member’s rights and dignity.
  • You received a bill from a provider that should be covered by KanCare (your MCO) and the MCO said they are not covering it.

• How do I submit a managed care grievance?

  The beneficiary or member or their authorized representative may submit a managed care grievance by telephone or in writing. The contractor cannot require a written form from the member or member’s representative for a grievance.
  
  To submit a managed care grievance by telephone call:
  
  Aetna 1-855-221-5656 or TTY 711
  Sunflower  1-877-644-4623   or TTY 711
  United  1-877-542-9238  or TTY 711
  
  To submit a managed care grievance by fax sent to:
  

  Aetna 1-833-857-7050
  Sunflower 1-888-453-4755 
  United Healthcare Not Available

  To submit a managed care grievance by mail sent to:
  
  Aetna
  Appeal and Grievance Department
  9401 Indian Greek Parkway, Suite 1300
  Overland Park, KS 66210

  Sunflower 
  Quality Department; ;
  8325 Lenexa Drive, Suite 200
  Lenexa, KS 66214
  
  United 
  Grievances and Appeals
  P.O. Box 31364
  Salt Lake City, UT 84131-0364
  
  To submit a managed care grievance in person go to:
  
  Aetna
  Appeal and Grievance Department
  9401 Indian Greek Parkway, Suite 1300
  Overland Park, KS 66210
  
  Sunflower  
  Quality Department                          
  8325 Lenexa Drive, Suite 200               
  Lenexa, KS 66214 
  
  United  
  10895 Grandview Drive 
  Suite 200
  Overland Park, KS 66210
  
  Is there a form I can use?
  No specific grievance form is required when submitting a member managed care grievance.

• Is there a deadline for filing a managed care member grievance?

  No, a beneficiary, member or their authorized representative may submit a managed care member grievance at any time.

• What happens once a managed care grievance has been submitted?

  The MCO will send the grievance acknowledgement letter to the beneficiary, member or their authorized representative within 10 calendar days from the date of receipt. For grievances resolved the same day of receipt, the MCO is not required to issue an acknowledgement, but will acknowledge receipt of the grievance in the notice of member grievance resolution. 

  The MCO will resolve the grievance and mail you or your representative the grievance resolution letter within 30 calendar days following the receipt of the grievance.