If this is an emergency or someone is in immediate danger, call 911. For a mental health or suicide crisis, call or text 988. To report suspected abuse, neglect, exploitation or abandonment of an adult age 18 or older, call the Pennsylvania Protective Services Hotline at 1-800-490-8505 (24 hours a day, 7 days a week). You may also tell your Service Coordinator, who is required to report suspected abuse.
Complaints, Questions & Appeals
Complaints, Questions & Appeals
Your concerns matter. PCC wants participants and families to feel comfortable asking questions, reporting a concern and getting clear information about the next steps available to them. You will never be treated differently or lose services because you asked a question, made a complaint or filed an appeal.
Which process is right for you?
There are different ways to raise a concern, depending on what the concern is about and who made the decision. PCC can help you figure out which one fits your situation.
- A complaint to PCC — for concerns about PCC or its staff, such as your Service Coordinator, communication, visits, timeliness or how you were treated. PCC reviews and responds to these concerns directly.
- A complaint, grievance or appeal with your managed care organization (MCO) — for Community HealthChoices (CHC) participants who disagree with a decision made by their CHC plan (for example, a service that was denied, reduced or stopped) or who have a concern about the plan or its providers. The MCO — not PCC — makes these decisions.
- A DHS Fair Hearing — a hearing through the Pennsylvania Department of Human Services when you disagree with a decision about your Medical Assistance or waiver services, as explained in the written notice you received. DHS — not PCC — makes these decisions.
Making a complaint to PCC
You can raise a concern with PCC in any of these ways:
- Call PCC at 215-725-7200 (TTY 711), Monday–Friday, 9:00 a.m.–5:00 p.m.
- Speak with your Service Coordinator or ask for their Team Manager.
- Submit the secure online PCC Complaint Form.
- Mail your concern to: Patient Care Coordination, Inc., Attn: Complaints, 475 N. 5th Street, Suite 2A, Philadelphia, PA 19123.
What happens next
We will acknowledge your concern within 24–48 business hours and provide a response or status update within 5–7 business days (excluding holidays). If more time is needed to fully resolve your concern, we will explain why and tell you when to expect our final response.
PCC will record your concern, look into it, tell you what we found and what action we took, and ask whether you are satisfied with the result. If your concern cannot be resolved, PCC will explain your other options and, when required, refer it to the Department of Human Services.
Please note: A complaint to PCC is not an MCO grievance or appeal and does not request a DHS Fair Hearing. It does not pause or extend any deadline listed on a notice from your health plan or from DHS. If you received a notice, follow the instructions on that notice — you can use more than one process at the same time.
If you disagree with a decision by your health plan or DHS
If you received a written notice that a service was denied, reduced, suspended or ended, you may have the right to file a complaint or grievance with your CHC plan and/or to request a DHS Fair Hearing. The notice tells you how to file and the deadline to do so. Filing quickly — and in some cases before the date on the notice — may allow your services to continue while your appeal is decided. Keep copies of all notices and letters you receive.
- Community HealthChoices (PA Health & Wellness): Call PA Health & Wellness Participant Services at 1-844-626-6813 (TTY 711), or follow the instructions in your notice and Participant Handbook.
- OBRA Waiver and Act 150 Program: Follow the fair hearing instructions on the notice you received from the Department of Human Services.
- Concerns about your CHC or waiver services: You may also call the Office of Long-Term Living (OLTL) Participant Helpline at 1-800-757-5042.
How PCC can help
PCC can help you understand the information in your notice, find the appeal, grievance or fair hearing instructions provided to you, locate the right contact information and forms, and connect you with an advocate or legal services. You may also choose a family member, friend, advocate or attorney to help you.
PCC does not make MCO or DHS decisions and cannot guarantee the outcome of a complaint, grievance, appeal or fair hearing.
Have a question?
For questions about your services, your plan or your rights, call your Service Coordinator or PCC at 215-725-7200. After hours, participants and providers can reach PCC’s on-call line 24/7/365 at 215-725-7200, Option 9.
Your rights when you raise a concern
- You will not be retaliated against, threatened or lose services for asking a question, making a complaint or filing an appeal.
- Your concern will be handled confidentially and shared only with those who need the information to address it, or as permitted by law.
- You may have someone help you or speak for you.
- Free language assistance, sign language interpreters, and information in large print or other formats are available. Call 215-725-7200 (TTY 711).
Discrimination concerns
If you believe you were discriminated against because of race, color, national origin, age, disability, sex or religion, you may file a complaint with PCC, the Pennsylvania Department of Human Services Bureau of Equal Opportunity at 717-787-1127 (TTY, Pennsylvania Relay 711), or with the U.S. Department of Health and Human Services Office for Civil Rights at 1-800-368-1019 (TDD 1-800-537-7697).