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How to file a Grievance
What is a grievance?
A grievance is a type of complaint that does not involve payment or denial of services by Simpra Advantage. For example, you would file a grievance if:
- You have a problem with things such as the quality of your care during a hospital stay;
- You feel you are being encouraged to leave your plan;
- Waiting times on the phone, at a network pharmacy, in the waiting room, or in the exam room are too long;
- Waiting too long for prescriptions to be filled;
- The way your doctors, network pharmacists or others behave;
- Not being able to reach someone by phone or obtain the information you need; or
- Lack of cleanliness or the condition of your doctor’s office.
Who can file a grievance?
A grievance may be filed by any of the following:
- You may file a grievance
- Your authorized representative
Why file a grievance?
You should file a grievance when you have any type of complaint with Simpra Advantage, especially if such complaints result from misinformation, misunderstanding, or lack of information.
Where can a grievance be filed?
File a standard grievance over the phone or in writing to:
Phone: 1-844-637-4770 (TTY/TDD 1-833-312-0044)
Appeals and Grievances Department
PO Box 981842
El Paso, TX 79998-1842
Can I expedite a grievance?
Yes, you may file an expedited grievance by calling:
1-844-637-4770 (TTY/TDD 1-833-312-0044)
If you disagree with Simpra Advantage’s decision to extend the timeframe or their decision to process your expedited request as a standard request. In such cases, you may file an expedited grievance and receive a response within twenty-four (24) hours of receipt.