TRICARE, Your Military Health Plan

In This Section:

• What Can be Appealed
• Appeal Requirements
• Appeal Process
• Medical Necessity Appeals
• Factual Appeals
• Grievances

Grievances

The grievance process gives you the opportunity to report a concern or complaint about your health care quality or service in writing. You should not file a grievance about an issue you can appeal.

What are some grievance issues?
Grievances may include these issues:

• The quality of health care or services aspects, such as accessibility, appropriateness, level, continuity or timeliness of care
• The demeanor or behavior of providers and their staff
• The performance of any part of the health care delivery system
• Patient safety practices

Who can file a grievance?
Any TRICARE beneficiary may file a grievance. A sponsor, parent, guardian or other representative may file a grievance for an eligible dependent child.

Who resolves grievances?
Your regional contractor is responsible for investigating and resolving all grievances.

When will I get a response about my grievance?
Grievances are resolved no later than 60 days from the date of receipt. When the grievance is resolved, you will be notified of the review completion.

How do I file a grievance?
Mail written notice of your grievance to the appropriate grievance address (see below) and be sure to include the following:

• Your name, address and telephone number
• Your Sponsor's Social Security number
• Your date of birth
• Your signature
• A description of the issue or concern that must include:
  • Date and time of the event
  • Name of the provider(s) and/or person(s) involved
  • Location of the event (address) 
  • The nature of the concern or complaint
  • Details describing the event or issue
  • Any appropriate supporting documents  

Note:  If you are filing a grievance on behalf of a dependent, provide the dependent's information, as well as your own in the grievance.

Grievance Addresses

Last Modified:April 10, 2012