Member materials and tools

File appeal or complaint

Appeals

If we do not give your doctor an okay for a service and you disagree (adverse determination), you can ask us to take a second look at our decision. If you want us to take a second look, you can call us at 800-327-8613 or TTY 800-424-1694 or send a letter to:

Magellan Complete Care
Attn: Complaint Coordinator
7600 Corporate Drive
Suite 400
Miami, FL 33126

If you call us, you must also write us within 10 days. You must tell us you disagree within 30 days of receiving our decision. We will have another person look at the decision. We will send you a letter with our final answer within 30 days.

Expedited Appeal

If you need a decision right away, please let us know it is urgent. This occurs when your health status is in danger. We will give you an answer within 72 hours. While you wait for our answer, you can continue to receive care. However, if the final decision is not in your favor, you may have to pay for the care. If you need help filing a grievance or appeal, please call us toll free at 800-327-8613 or TTY 800-424-1694. We are here from 8:00 am -7:00 pm Monday -Friday.

Here's who can help you file a grievance or appeal: 

  • Magellan Complete Care
  • You
  • Your legal guardian
  • Your doctor

 

Complaints

If you are not happy with us, your provider, or your services for any reason, you or someone who can act for you, can tell us. Call us at 800-327-8613 or TTY 800-424-1694, email CustomerService@MagellanCompleteCare.com(need to check this email), or send a letter to:

Magellan Complete Care
Attn: Complaint Coordinator
7600 Corporate Drive
Suite 400
Miami, FL 3312

We will resolve your complaint as soon as we can. If we cannot give you an answer in 1 day, your complaint will now be a grievance.

Grievances

A grievance is a formal complaint or a complaint that is not resolved in a day. Call us at 800-327-8613 or TTY 800-424-1694 or send a letter to:

Magellan Complete Care
Attn: Complaint Coordinator
7600 Corporate Drive
Suite 400
Miami, FL 33126

We can help you create a grievance. You must call within 1 year of the issue. We must resolve your issue within 30 days. We will send you a letter with our answer.