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Complaint, Grievance, and DHS Fair Hearing Process

PA Health & Wellness recognizes that there are times when participants may not be satisfied with a matter handled by PA Health & Wellness. Participants, or their authorized representative, have the right to file a complaint related to that matter. The Complaint and Grievance Procedures will describe the process to file a Complaint, Grievance or Fair Hearing along with the response and resolution timeframes and the complainant (grievant)’s rights during the process.

A complaint is an expression of dissatisfaction communicated by a complainant, orally or in writing, about any matter related to PA Health & Wellness, a network contracted provider or the services they have received. As provided by 42 C.F.R. §438.400, possible subjects for complaints include, but are not limited to:

  • The quality of care of services provided
  • Aspects of interpersonal relationships such as rudeness of a provider or employee
  • Failure to respect the participant’s rights.

When PA Health & Wellness denies, decreases, or approves a service or item different than the service or item you requested because it is not medically necessary, you will get a notice telling you PA Health & Wellness’s decision. A Grievance is when you tell PA Health & Wellness you disagree with PA Health & Wellness’s decision.

In some cases you can ask the Department of Human Services to hold a hearing because you are unhappy about or do not agree with something PA Health & Wellness did or did not do.  These hearings are called “Fair Hearings.”  You can ask for a Fair Hearing after PA Health & Wellness decides your First Level Complaint or decides your Grievance.

If you're interested in becoming a panel member on our Complaint and Grievance Committee, please click here

You may file a complaint or grievance via phone, fax or mail:

  • Call 1-844-626-6813 and TTY 1-844-349-8916
  • Fax 1-844-873-7451
  • Write and mail to PA Health & Wellness, Attention Complaint and Grievance Unit, 300 Corporate Center Drive, Camp Hill, PA 17011