Grievance Procedure

You should discuss your concerns with your mental health therapist or case manager. If you are not satisfied with the answer, make your grievance known to the program manager or clinical director of your GOBHI Provider clinic. You may also follow the steps mentioned below if your concerns are not being addressed by your GOBHI Provider. You can request a grievance form at any time from your GOBHI Provider or by calling GOBHI Member Services at 1-800-0493-0040. Filing a grievance will not affect services you are receiving.

1. Make your concern known to our Quality Improvement Staff (QIS) by calling GOBHI Member Services or by filling out the grievance form and following the instructions. A Quality Improvement Staff member will be available for you to discuss your concern(s) with.

2. The QIS member will discuss your concern with all parties involved. The QIS may ask these people to write down what happened. The QIS member will conduct the investigation.

3. The QIS member will look at the information and decide what to do. The QIS member will contact you by phone or write you about what will happen next. The QIS will try to address your concern in 20 days.

If you are not satisfied with this answer, you may request an appeal in writing. GOBHI’s Quality Improvement Coordinator and Medical Director will evaluate your appeal. A written resolution to your appeal will be given within 45 days of your appeal request.

If you are unhappy with this answer, you may ask for a Department of Human Services (DHS) Administrative Hearing. Do this by calling your DHS worker and requesting an Administrative Hearing Form (AFS 443). The hearing request must be made within 45 days from the date of our written answer.

Urgent Medical Problems: If you think your issue must be addressed fast for medical reasons, ask your DHS worker for an “expedited hearing.” Your worker will call the DHS Medical Director to see if your issue needs a quick hearing.

You may call your DHS worker at any step in this grievance procedure and request an administrative hearing.

Records about grievances and hearingsare only shared with people who can solve your issue.