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Grievances and Appeals

For more information related to Grievances and Appeals please see:

EOC Chapter 9

Appointing a Representative - Instructions & Form

People who want to represent a member can be appointed or authorized by the member. A member can authorize anyone (like a relative, friend, advocate, an attorney, or a doctor) to act as his or her representative and file an appeal on his or her behalf.

A representative (or surrogate) can also be authorized by the court or act on behalf of the member in accordance with State law to file an appeal for an enrollee. A surrogate could include, but is not limited to, a court appointed guardian, an individual who has Durable Power of Attorney, or a health care proxy, or a person designated under a health care consent statute.

How to authorize a representative:

The member must sign, date, and complete a representative form. The person acting on behalf of the member must sign, date and complete the same form.

If a member is incapacitated or legally incompetent a surrogate is not required to submit an Appointment of Representation Form. The surrogate will need to give ONECare copies of the legal papers supporting his or her status as the member’s authorized representative. ONECare requires a copy of the completed and signed Appointment of Representative Form to process an appeal filed by the member’s representative. The form will be valid during the entire appeal process.

The Appointment of Representative Form is valid for one year from the date indicated on the form. A member can revoke the authorization at any time.

How to Obtain an Aggregate Number of Grievances, Appeals and Exceptions Filed with ONECare

To obtain an aggregate number of ONECare grievances, appeals and exceptions, please call ONECare Member Services at 1-877-778-1855 (TTY 711) from 8 a.m. to 8 p.m., seven days a week from October 1 through February 14. After February 14, your call will be routed to our after-hours service on weekends and holidays.

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H5430_18_024_MK CMS Approved Pending

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