A grievance is a written complaint or concern about a medical provider, HNFS or the TRICARE program in general. Authorization appeals, claims appeals and claim review issues are separate from grievances. The following are examples of grievances:
- the quality of care given by a provider (inappropriate care, not enough care, poor results)
- the attitude or behavior of providers and their staff
- incorrect information
- delays or errors in processing authorizations
- patient safety issues at a facility or doctor’s office
- privacy concerns
Note: Disputing a Point of Service charge should not be submitted as a grievance. Please visit our Disputing Point of Service Charges page to learn more.
Who can file a grievance?
Anyone can file a grievance; however, if the grievance is about someone other than the person who filed the grievance, HNFS may not be able to give a full response without an Authorization for Disclosure of Medical or Dental Information form on file. This generally applies to spouses and parents of adult children submitting grievances about their spouse or adult child.
What is the grievance process?
Health Net Federal Services conducts a thorough investigation of the concerns and takes actions as necessary to improve services. If necessary, we will contact the involved provider(s) and various HNFS departments to gather additional information. Generally, we do not contact the beneficiary unless information in the grievance is unclear. The person who submitted the grievance will receive a written response, usually within 60 days.
How is a grievance submitted?
Print an HNFS Grievance Form or send a letter with the following:
- name, address and telephone number of the person submitting the grievance
- the beneficiary's name, address and telephone number if different from the submitter
- the sponsor's Social Security number or the beneficiary's DEERS Benefit Number (DBN)
- a description of the issue(s), including the day, time and details
- the name of the involved provider(s) or HNFS associates or departments
- the provider’s address if the complaint is about a provider
- any appropriate supporting documents
- if necessary, an Authorization for Disclosure of Medical or Dental Information form
Fax to: 1-844-802-2531
Mail to: Health Net Federal Services, LLC
PO Box 8128
Virginia Beach, VA 23450-8128