Complaints and Grievances Process
WellKids by PA Health and Wellness recognizes that there are times when members and providers may not be satisfied with a matter handled by WellKids by PA Health and Wellness. Members and providers have the right to file a complaint related to that matter.
If a provider or WellKids by PA Health and Wellness does something you are unhappy about or disagree with, you can tell WellKids by PA Health and Wellness or the Department of Human Services what the provider or WellKids by PA Health and Wellness has done. This section describes what you can do and what will happen.
Complaints
What Is a Complaint?
A Complaint is when you tell WellKids by PA Health and Wellness you are unhappy with WellKids by PA Health and Wellness or your provider or do not agree with a decision by WellKids by PA Health and Wellness.
Some things you may complain about:
- You are unhappy with the care you are getting.
- You cannot get the service or item you want because it is not a covered service or item.
- You have not received services that WellKids by PA Health and Wellness has approved.
- You were denied a request to disagree with a decision that you have to pay your provider.
Grievances
What is a Grievance?
When WellKids by PA Health and Wellness denies or decreases a service or item you requested because it is not medically necessary or approves a service or item different than the service or item you requested, you will receive a notice telling you WellKids by PA Health and Wellness’s decision.
A Grievance is when you tell WellKids by PA Health and Wellness you disagree with WellKids by PA Health and Wellness’s decision.
What Should I Do if I Have a Grievance?
To file a Grievance:
- Call WellKids by PA Health and Wellness at 1-855-445-1920 (TTY: 711) and tell WellKids by PA Health and Wellness your Grievance, or
- Write down your Grievance and send it to WellKids by PA Health and Wellness by mail or fax, or
- Fill out the Complaint/Grievance Request Form included in the denial notice you received from WellKids by PA Health and Wellness and send it to WellKids by PA Health and Wellness by mail or fax.
You may file a complaint or grievance via phone, fax or mail:
WellKids Complaints and Grievances Contact Information
Mailing Address:
WellKids by PA Health and Wellness
Attn: Complaints and Grievances Unit
1700 Bent Creek Blvd, Suite 200
Mechanicsburg, PA 17050
Fax: 844-747-0599
Email: CHIPComplaintsandGrievances@pahealthwellness.com
WellKids Behavioral Health Appeals
Mailing Address:
P.O. Box 10378
Van Nuys, CA 91410-0378
Fax: 866-714-7991
Email: CBHAPPEALS@CENTENE.COM
What Should I Do if I Have a Complaint?
To file a first level Complaint:
- Call WellKids by PA Health and Wellness at 1-855-445-1920 (TTY: 711) and tell WellKids by PA Health and Wellness your Complaint.
- Write down your Complaint and send it to WellKids by PA Health and Wellness by mail or fax.
- If you received a notice from WellKids by PA Health and Wellness telling you WellKids by PA Health and Wellness’s decision, and the notice included a Complaint/Grievance Request Form, fill out the form and send it to WellKids by PA Health and Wellness by mail or fax:
Well Kids Complaints and Grievances Contact Information
Mailing Address:
WellKids by PA Health and Wellness
Attn: Complaints and Grievances Unit
1700 Bent Creek Blvd, Suite 200
Mechanicsburg, PA 17050
Fax: 844-747-0599
Email: CHIPComplaintsandGrievances@pahealthwellness.com
Well Kids Behavioral Health Appeals
Mailing Address:
P.O. Box 10378
Van Nuys, CA 91410-0378
Fax: 866-714-7991
Email: CBHAPPEALS@CENTENE.COM
Your provider can file a Complaint for you if you give the provider your consent in writing to do so.
What Should I Do if I Want to File a Second Level Complaint?
To file a Second Level Complaint:
- Call WellKids by PA Health and Wellness at 1-855-445-1920 (TTY: 711) and tell WellKids by PA Health and Wellness your Second Level Complaint, or
- Write down your Second Level Complaint and send it to WellKids by PA Health and Wellness by mail or fax, or
- Fill out the Complaint Request Form included in your Complaint decision notice and send it to WellKids by PA Health and Wellness by mail or fax:
WellKids by PA Health and Wellness’s address and fax number for Second Level Complaints:
Mailing Address
WellKids by PA Health and Wellness
Attn: Complaints and Grievances Unit
1700 Bent Creek Blvd, Suite 200
Mechanicsburg, PA 17050
Email: CHIPComplaintsandGrievances@pahealthwellness.com
Fax: 844-747-0599
Well Kids Behavioral Health Appeals
Mailing Address:
P.O. Box 10378
Van Nuys, CA 91410-0378
Fax: 866-714-7991
Email: CBHAPPEALS@CENTENE.COM
How Do I Ask for an External Review of a Complaint?
To ask for an external review for a Complaint:
- Call WellKids by PA Health and Wellness at 1-855-445-1920 (TTY: 711) and tell WellKids by PA Health and Wellness your Complaint, or
- Write down your Complaint and send it to WellKids by PA Health and Wellness by mail to:
WellKids by PA Health and Wellness
Attn: Complaints and Grievances Unit
1700 Bent Creek Blvd, Suite 200
Mechanicsburg, PA 17050
Email: CHIPComplaintsandGrievances@pahealthwellness.com
Fax: 844-747-0599
Well Kids Behavioral Health Appeals
Mailing Address:
P.O. Box 10378
Van Nuys, CA 91410-0378
Fax: 866-714-7991
Email: CBHAPPEALS@CENTENE.COM
What is a Grievance?
When WellKids by PA Health and Wellness denies or decreases a service or item you requested because it is not medically necessary or approves a service or item different than the service or item you requested, you will receive a notice telling you WellKids by PA Health and Wellness’s decision.
A Grievance is when you tell WellKids by PA Health and Wellness you disagree with WellKids by PA Health and Wellness’s decision.
What Should I Do if I Have a Grievance?
To file a Grievance:
- Call WellKids by PA Health and Wellness at 1-855-445-1920 (TTY: 711) and tell WellKids by PA Health and Wellness your Grievance, or
- Write down your Grievance and send it to WellKids by PA Health and Wellness by mail or fax, or
- Fill out the Complaint/Grievance Request Form included in the denial notice you received from WellKids by PA Health and Wellness and send it to WellKids by PA Health and Wellness by mail or fax.
WellKids by PA Health and Wellness’s address and fax number for Grievances:
Mailing Address:
WellKids by PA Health and Wellness
Attn: Complaints and Grievances Unit
1700 Bent Creek Blvd, Suite 200
Mechanicsburg, PA 17050
Email: CHIPComplaintsandGrievances@pahealthwellness.com
Fax: 844-747-0599
Well Kids Behavioral Health Appeals
Mailing Address:
P.O. Box 10378
Van Nuys, CA 91410-0378
Fax: 866-714-7991
Email: CBHAPPEALS@CENTENE.COM
Your provider can file a Grievance for you if you give the provider your consent in writing to do so. If your provider files a Grievance for you, you cannot file a separate Grievance on your own.
Expedited Complaints and Grievances
What Can I Do if My Health Is at Immediate Risk?
If your doctor or dentist believes that waiting to get a decision about your Complaint or Grievance could harm your health, you or your doctor or dentist may ask that your Complaint or Grievance be decided more quickly. For your Complaint or Grievance to be decided more quickly:
- You must ask WellKids by PA Health and Wellness for an early decision in writing, by fax, by email, or orally.
- Your doctor or dentist should fax a signed letter to 844-747-0599 within 72 hours of your request for an early decision that explains why WellKids by PA Health and Wellness taking the standard amount of time to tell you the decision about your Complaint or Grievance could harm your health.
If WellKids by PA Health and Wellness does not receive a letter from your doctor or dentist, and the information provided does not show that taking the usual amount of time to decide your Complaint or Grievance could harm your health, WellKids by PA Health and Wellness will decide your Complaint or Grievance in the usual time frame of 45 days from when WellKids by PA Health and Wellness first received your Complaint or Grievance.