The Funds has a grievance procedure to address complaints about quality of service or any other issue that is not about denial of service or claim. You may submit an informal complaint to the Funds either by telephone or in writing. To discuss a concern you can call the Health Call Center at 1-800-291-1425.
Written complaints should be mailed to:
UMWA Health and Retirement Funds
160 Heartland Drive
Beckley, West Virginia 25802
All written grievances should include your name, address and a full explanation of your complaint, including specific dates, persons, places, and events. In a clear statement, please tell us how you believe the problem should be resolved.
If you are a Medicare-eligible beneficiary, you may also file a complaint about the quality of your care with your local Medicare Quality Improvement Organization.
Often complaints result from simple misunderstandings that can be resolved informally through discussions among the parties involved. The Health Call Center representative will log your call or letter and the nature of the issue and attempt to resolve the problem. If we cannot immediately resolve your concern, we will investigate it and respond to you by phone or letter within 30 days unless it is necessary to take an extension of up to14 calendar days to gather additional information/medical records and the extension of time benefits you. You will be notified in writing if the Funds need additional time (up to 14 calendar days) to consider a grievance case.
We are committed to making every effort to informally resolve your grievance. If, however, the Funds’ representative cannot resolve your complaint or inquiry to your satisfaction, you or your authorized representative may file a second level grievance. This must be done in writing and sent to the address listed above. Funds’ staff will review your grievance for completeness and may ask for additional information. Once the grievance is complete, it will be referred to an Internal Grievance Committee for review. This committee is made up of one or more internal Funds’ management staff who has not previously been involved in your dispute.
The Internal Committee will review your complaint and make a decision within 30 days of the referral of your grievance unless special circumstances (such as the need to schedule a meeting with you and/or other involved parties) require an extension. If an extension is necessary, you will be notified and will receive a decision in writing from the Committee no later than 90 days after the referral of your grievance. This decision will be final for the Funds.