Member Grievances and Appeals

Martin's Point plan members or their authorized representatives have the right to express complaints, frustrations, and disagreement about their experience interacting with health care providers, the plan and/or its administrators. Under state and federal law, members can express those complaints through the Martin's Point grievance and appeals process. Providers may also file a grievance/appeal on behalf of a current or former member by obtaining authorization from the member.

Grievance

A grievance is a member complaint about the way the health plan or drug plan is giving care. For example, a member may file a grievance if they have a problem calling the plan or if they’re unhappy with the way a staff person at the plan behaved towards them. However, if they have a complaint about a plan’s refusal to cover a service, supply or prescriptions, they file an appeal.

Appeal

An appeal is the action taken if the provider or the member disagrees with a coverage or payment decision made by the plan.
Members or their authorized representatives, may submit a grievance by calling Member Services at:
US Family Health Plan Member Services: 1-888-674-8734
Generations Advantage Member Services: 1-866-544-7504 (TTY: 711)
Written grievances can be sent to:
US Family Health Plan Grievances
Martin's Point Health Care
P.O. Box 9746
Portland, ME 04104-5040
Generations Advantage Grievances
Martin's Point Health Care
P.O. Box 8832
Portland, ME 04104-9861
For more details on the Grievance and Appeals process for each plan, please visit: