Complaints/Grievances and Appeals

Complaints/Grievances

A Complaint/Grievance is when you tell Magellan about something you are unhappy about. It could be about Magellan or a provider. You can file a Complaint/Grievance when you are unhappy about things like:

  • Access to care
  • Quality of services
  • How Magellan staff treat you
  • How a provider treats you
  • Not having your rights respected
  • Not being treated with dignity

You can file a Complaint/Grievance in one of these ways:

Online: Fill out this online form or download and print a form to fill out and send to Magellan.

Email: Email a completed form or a description of your Complaint/Grievance to NevadaAppealsGrievances@magellanhealth.com.

Fax: Fax a completed form or a letter describing your Complaint/Grievance to 1-888-656-5426.

Mail: Complete a form and mail it to:
Magellan of Nevada
Appeals & Grievance Department
P.O. Box 34028
Reno, NV 89533

Call: 1-833-396-4310 (TTY 711) between 8:00 a.m. – 5:00 p.m. local time. Tell the person who answers the phone that you want to file a grievance and complaint.

Magellan will try to resolve your Complaint/Grievance as soon as possible. If you file your Complaint/Grievance in writing, we will mail you a letter. The letter will explain that Magellan received your Complaint/Grievance. We may contact you to make sure you are OK and talk about your Complaint/Grievance. We may need to report your Complaint/Grievance to the State of Nevada or child protective services if a provider hurt you or treated you poorly.

After we resolve your Complaint/Grievance, we will send you a letter within 30 calendar days of when we received your Complaint/Grievance. The letter will explain what we did to solve your problem.

Appeals

An Appeal is a request for Magellan to review a decision we made about your care or something we did not do. You can file an Appeal if Magellan:

  • Does not approve a service or only approves part of a service your provider asked for
  • Reduces, holds up or cancels a service that we pre-authorized
  • Will not pay for a service or part of a service
  • Does not provide services in a timely manner
  • Fails to process appeals within the required timeframes

If one of these things happens, Magellan will tell you and your provider in a letter. The letter is called a Notice of Denial. The Notice of Denial will explain why we made our decision and tell you how to file an Appeal.

You can ask for a free copy of all of the information we used to make our decision by calling Magellan at 1-833-396-4310 (TTY 711). If you think we made a mistake, you can file an Appeal. You have 60 calendar days from the date on the Notice of Denial letter to file an Appeal.

 

You can file a Complaint/Grievance and Appeal yourself. You can also ask someone you trust to file one for you. If you want someone to file an Appeal for you, please fill out and sign the Authorization of Use and Disclosure of Protected Health Information (AUD) form.

 

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