TABLE 21-6, FIRST-LEVEL MEMBER GRIEVANCE

COMMERCIAL AND MEDICARE PLANS

BENEFIT PLAN(S)

WHAT/HOW/WHERE TO FILE:

INSTRUCTIONS

TIME FRAMES

ADDITIONAL RIGHTS

Initial Member Filing

ConnectiCare Acknowledges Receipt

ConnectiCare Determination Notification

ConnectiCare

Write to:

ConnectiCare
Grievance and Appeal Dept.
P.O. Box 4061
Farmington, CT  06034

Telephone:
800-251-7722

60 calendar days for Medicare and 180 calendar days for commercial from receipt of 
written adverse determination

3 business days for commercial and 15 calendar days for Medicare from receipt of the grievance

30 calendar days (plus possible 14 day extension) for Medicare and 20 business days for commercial from receipt of the grievance

N/A

ConnectiCare of Massachusetts

Unless otherwise directed in the denial letter, write to:

ConnectiCare
Grievance and Appeal Dept.
P.O. Box 4061
Farmington, CT  06034

Telephone:
800-251-7722

60 calendar days for Medicare and 180 calendar days for commercial from receipt of 
written adverse determination

15 calendar days for commercial from receipt of the grievance

30 calendar days from receipt of grievance