Appeals and Grievances

Tribute^® HMO SNP allows members to submit complaints to the plan which may become either an appeal or a grievance.

• If a member or their representative is dissatisfied with the services provided, such as sales, enrollment, or service processes, they have the right to file a grievance with the plan. The plan will review the grievance, take necessary action, and notify the member or their representative. A grievance does not involve an appeal.
• Members have additional options to expedite an appeal if his or her physician believes that waiting for a decision under the standard time frame could place the enrollee’s life, health, or ability to regain maximum function in serious jeopardy. An expedited appeal is a request for a pre-service or concurrent appeal that must be reviewed within 72 hours after we receive it. An expedited appeal can be requested verbally or in writing by you, an appointed representative or your treating physician. If the appeal request includes one of the following key words it will be considered an expedited appeal: Expedited, Fast, STAT, Urgent, ASAP, Rush, Immediate, Life Threatening, etc. Note: Appeal requests for denial of payments cannot be expedited. Expedited appeals for Medicare Advantage plans may be extended by 14 days.
• Value-added services included with the plan do not have appeal rights; however, members may file grievances regarding value added-services received.

For more information about the appeals and grievances processes, please contact us at 1-800-817-3515, 8:00 a.m. to 8:00 p.m. in your local time zone (TTY users call 1-800-958-2692) 7 days a week. You can find more information about what your plan covers in your Evidence of Coverage.

You may submit your complaint in writing to the plan to the following address:

• Tribute
  c/o Appeals and Grievances
  P.O. Box 742608
  Houston, Texas 77274
• Or Via Fax: 1-800-817-3516

If you wish to request an aggregate number of grievances, appeals and exceptions filed with Tribute, contact  us at 1-800-817-3515, 8:00 a.m. to 8:00 p.m. in your local time zone (TTY users call 1-800-958-2692) 7 days a week. Please refer to your Evidence of Coverage on Complaints in Chapter 2, Section 1 for more information on what to do next.

Our decision is final and cannot be appealed. However, you always have the option to make a complaint with Medicare

If you would like to submit your complaint to Medicare, click on the Medicare Complaint Form to access the form. Please note you do not have to use the Medicare Compliant Form to make a complaint to Medicare. Your options include:

• The Office of the Medicare Ombudsman (OMO) helps you with complaints, grievances and information requests.
• The Medicare.gov website for more information. Per Medicare regulations, all grievance decisions are final.
• Calling Medicare at 1-800-MEDICARE (1-800-633-4227); TTY users should call 1-877-486-2048, 24 hours a day, 7 days a week.

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