Grievance

A grievance is a formal complaint filed by a TRICARE beneficiary about issues related to the quality of care, access to services, administrative problems, or customer service concerns that do not involve claim payment disputes. Grievances are distinct from appeals, which address specific claim denials.

Common reasons for filing a grievance: • Difficulty accessing timely appointments • Quality of care concerns • Rude or unprofessional behavior by providers or staff • Problems with referral or authorization processing • Issues with prescription drug access • Customer service complaints • Billing or administrative errors

How to file a TRICARE grievance: • Contact your regional contractor (Humana Military or TriWest) • Submit a written grievance through the contractor's website or by mail • Call the TRICARE customer service line to initiate a grievance • Contact the Defense Health Agency if the issue is not resolved

Grievance resolution process: • Your regional contractor reviews the grievance • Investigation is conducted as needed • Response is provided within required timeframes • If unresolved, the grievance can be escalated • The Defense Health Agency provides oversight

Beneficiaries are protected from retaliation for filing grievances. Documenting your concerns in writing and keeping records of all communications helps ensure your grievance is properly addressed.