Complaints, Grievances and Appeals
You have the right to complain or file a grievance to express dissatisfaction about anything related to your care at CSAC: the quality of services, aspects of interpersonal relationships, concerns with management, decisions about eligibility for service, placement on a waiting list, reduction in service, denial or suspension of service, physical harm, or anything else that you are not happy with. CSAC will provide assistance to you or your representative to complete the complaint or grievance.
Complaints may be spoken or written. You are encouraged to resolve issues of dissatisfaction in an informal manner directly with the parties involved if you are comfortable doing so.
What if I want to File a Grievance?
Grievances may be verbal or written. To file a formal grievance, you or your representative must contact CSAC by phone, mail, or in person and request a written response from CSAC.
If you have an emergency situation, be sure to tell us that your problem is urgent so that we can respond quickly.
What Will Happen Next?
We will take your concerns seriously and try to fix the problem. We will respond to you in a timely way. When we respond, we will explain as clearly as possible the reasons for our decision. No one at CSAC will treat you badly. There will be no negative impact in your relationship with CSAC because you expressed your dissatisfaction to us. Your complaint or grievance will be considered confidential.
Deadline for Grievances
You should file your grievance as soon as possible after the problem or issue arises, but you must file it within 60 days of the incident or decision.
An "Appeal" means making a formal verbal or written request for CSAC to rethink its decision on an action. You can file a formal appeal when you do not agree with proposed changes to the services offered as part of your treatment plan, for example. Another example would be if you request a new service but CSAC denies your request. Other examples include but are not limited to:
* Denial, or limitation of authorization of a requested covered service or eligibility, including the type, scope, or level of service
* Failure to provide services in a timely manner
* Failure to provide clinically indicated covered services
* Denial of request covered services outside Medicaid network
You may file an appeal by contacting CSAC's Grievance and Appeals Coordinator through our front desk at 388-6751. You must tell the receptionist that you wish to file an appeal to a CSAC action.
If you are not sure what to do or have questions, the Vermont Office of Health Care Ombudsman may also be able to advise you at 1-800-917-7787