Filing a Grievance
Sunflower Health Plan wants to fully resolve your problems or concerns. A grievance is an expression of dissatisfaction. You can file a grievance or protest to Sunflower about a wrong committed to you by the health plan or one of its providers. Possible subjects for grievances include, but are not limited to, the quality of care or services provided, acts of rudeness by a provider or employee, or failure to respect a member’s rights.
- Sunflower will not treat you differently if you file a grievance.
- There are no grievance rights for Value-Added Benefits (or Value-Added Services).
- Filing a grievance will not affect your healthcare services.
- A grievance may be filed verbally by calling the plan or in writing.
- For Sunflower to completely review your concern, please provide your first and last name, Medicaid ID, phone number where we can reach you, what you are unhappy with, and what you would like to happen when contacting us to file a grievance.
- You may allow someone to file a grievance for you. To do so, you must sign a form giving that person permission to act on your behalf. To obtain this form, contact Customer Service or get it from the Sunflower website. You will need to fill it out and return it by mail or fax before Sunflower can review your concern with the person you designate.
- Information or documents that support the grievance can be sent to Sunflower by mail or fax.
- Documentation used to make the decision about the grievance will be provided to you upon your request.
- Sunflower will provide assistance in filling out any forms needed for the process.
- If you do not like the resolution provided by Sunflower for your grievance, you can ask for them to review the decision.
- The KanCare Ombudsman is a resource to members for assistance with rights and responsibilities under KanCare, when you need help solving a problem with Sunflower, when you do not think you are getting the care you need, or when you feel your rights are violated. Please refer to the Appeal page for Ombudsman contact information.
- You may request a grievance to be reviewed as clinically urgent. Clinically urgent grievances will be resolved in 72 hours. However, if the clinically urgent grievance request does not meet criteria as clinically urgent it will be handled in the standard grievance timeframe of 30 calendar days.
Sunflower wants to resolve your concerns quickly. If we cannot resolve your concern in 30 calendar days, we can ask for an extension to gather more information to assist you. You can also ask for an extension. The request for an extension to resolve the grievance must be made 2 business days before the 30 calendar day deadline to the State. If an extension is needed, we will notify you in writing of the reason we need more time to resolve your concern.
Grievance Process Timeline
- Step 1: Member files grievance by calling Customer Service, or by sending a fax or letter to Sunflower.
- Step 2: Sunflower sends a letter within 10 calendar days of receipt of the grievance to let member know the grievance has been received, unless the grievance was resolved on the same day it was received by Sunflower.
- Step 3: Sunflower will resolve the grievance and send the member a notice of their decision within 30 calendar days of receipt of the grievance.