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Managing

integrated healthcare

with a conscience.

What can I do if I have a complaint about my care?

 

If you are not happy with the care you are getting, try to solve any issues at the lowest possible level by talking with your provider or NARBHA

 

What is a formal complaint and how do I make one?

A formal complaint is when you are not happy with any aspect of your care.  Reasons for complaints could include such things as:

  • The quality of care or services you got,
  • A disagreement with the denial to process an appeal as expedited,
  • The failure of a provider to respect a person's rights, or
  • A provider or employee of a provider being rude to you.

 

Some issues require you to file an appeal instead of a formal complaint.  This process is described in the section called, "What is an appeal and how do I file an appeal."  These issues include:

  • The denial or limited approval of a service asked for by your provider or clinical team,
  • The reduction, suspension, or termination of a service you were receiving,
  • The denial, in whole or part, of payment for a service,
  • The failure to provide services in a timely manner,
  • The failure to act within timeframes for resolving an appeal or complaint, and
  • The denial of a request for services outside of the provider network when services are not available within the provider network.

 

Formal complaints can be made either orally or in writing.  You can call or write to NARBHA Member Services at (928) 774-7128 or toll-free at 1-800-640-2123; for hearing impaired, please use the Arizona Relay Service at 711 or 1-800-367-8939 or internet assistance at http://www.azrelay.org/ or write NARBHA 1300 South Yale Street, Flagstaff, AZ 86001.

 

You will get oral or written notice that your complaint was received within 5 working days.  A decision regarding the results of your complaint must be given to you within 90 days of making your complaint unless an extension is asked for.  An extension can be asked for by you or NARBHA to gather more information.  You will be given notice if an extension is asked for by NARBHA.