Grievances and Appeals

Your health and satisfaction are important to us. When you have a problem or concern, please call RiverSpring FIDA Plan first at 1-800-950-9000. Our participant service staff will work with you to try to find a satisfactory solution to your problem.

You can also contact us to ask about the grievance and appeals process, or a status update on the processing of your grievance or appeal. For information on the total number of grievances, appeals and exceptions filed with RiverSpring FIDA Plan, please contact RiverSpring FIDA Plan at 1-800-950-9000.

For more information, see the Participant Handbook

Grievances

A grievance is a complaint that you have a problem or concern about your covered services or care. This includes any concerns about the quality of your care, our network providers, or our network pharmacies.

If you need to file a grievance with directly with Medicare, please fill out the Medicare Complaint Form

Appeals

An appeal is a way for you to challenge a coverage decision if you think it is wrong. You can ask RiverSpring FIDA Plan to change a coverage decision by filing an appeal.

Appointment of representative

If you need help with a grievance, coverage decision or appeal, you can ask someone to act on your behalf by naming another person to act for you as your “representative.”

The Appointment of Representative form must be signed by you and by the person whom you would like to act on your behalf.

You or your appointed representative can file a grievance or appeal by calling or writing to us.

The State of New York has created a participant ombudsman program called the Independent Consumer Advocacy Network (ICAN) to provide Participants free, confidential assistance on any services offered by RiverSpring FIDA Plan. ICAN may be reached toll free at 1-844-614-8800 or online at http://www.icannys.org (Clicking on this link will take you away from the RiverSpring FIDA Plan website.)

Please follow the link for the Notice of Nondicrimination and Accessibility Requirements

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This page was last updated on March 29, 2017 09:30:00 EST