Members Resources

Find tools, information, and other resources to help you get the most out of your benefits

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 711)

Fax:  1-833-610-2380

Mail:

Simpra Advantage
Appeals and Grievances Department
PO Box 2190
Glen Allen, VA 23058

File a complaint directly to Medicare by filling out the complaint form.

Can I expedite a grievance?

Yes, you may file an expedited grievance by calling:

1-844-637-4770 (TTY 711)

Yes. 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.