Filing a Grievance
We hope our members will always be satisfied with Absolute Total Care and our providers. If you are not satisfied, you have the right to file a grievance. A grievance is an expression of dissatisfaction about any matter other than an adverse benefit determination, such as:
- Wait time to see a doctor
- Being treated unfairly by office staff
- Unclean facilities
You have the right to file a grievance. A grievance may be filed at any time. If you need assistance with your grievance please call Absolute Total Care at 1-866-433-6041 (TTY: 711) and we will assist you in filing your grievance. This includes providing assistance with accessing interpreter services and hearing impaired services, if needed, at no cost to you. We cannot and will not treat you differently because you have filed a grievance. Your benefits will not be affected.
Who can file a grievance?
- An Absolute Total Care member or a member’s authorized representative.
- An authorized representative is a person or provider a member gives the right to act on their behalf.
- The member can give permission for a person or a provider to act on their behalf in writing or by completing the Appointment of Authorized Representative Form found on the Member Handbooks and Forms page.
How to file a grievance:
- Call Member Services at 1-866-433-6041 (TTY: 711).
- Mail, email, or fax a completed Grievance Form or written letter telling us why you are not satisfied. You can obtain a Grievance Form on the Member Handbooks and Forms page. Be sure to include:
- Your first and last name
- Your Absolute Total Care member ID card number
- Your address and telephone number
- The reason for your grievance
- Mail: Absolute Total Care Grievance and Appeals Coordinator
100 Center Point Circle
Columbia SC 29210
- Fax: 1-866-918-4457
- Email: SC_Appeals_And_Grievs@centene.com
- Present your evidence in person at the address above
When will Absolute Total Care tell me the decision about my grievance?
Absolute Total Care will send you a letter telling you that we received your grievance within five calendar days. We will try to make a decision right away. Sometimes we can resolve it over the phone. If not, we will give you a written decision within 90 calendar days after we get your grievance.
Absolute Total Care may extend the timeframe to resolve the grievance up to 14 calendar days if:
- You or your authorized representative request an extension, or
- Absolute Total Care can demonstrate that there is a need for additional information that is in the member’s best interest.
If an extension is made to your grievance, we will contact you and your provider promptly by phone to let you know of our decision. We will also send you a letter within two calendar days that includes the reason for the extension and your right to file a grievance if you disagree with our decision.
All clinically urgent grievances will be reviewed by a medical director and resolved within 72 hours from receipt by Absolute Total Care.
If you are not satisfied with the first decision of the grievance, you can request a second review of your grievance within 30 calendar days from the receipt of the notice of the original decision. Absolute Total Care will review your grievance again. The second grievance review will be completed by someone who did not make the decision on the first grievance review. After the first and second review of the grievance have been completed, you do not have the right to file a State Fair Hearing.