Complaints, Grievance, and Appeals

Complaints and Grievances

Empower cares about the care and the service we provide. If you are not happy with any part of your care, please call us at 866-261-1286 | TTY: 711 or email at complaintsandgrievance@empowerhcs.com and we will call you. Our goal is to help you with your complaint with a single call. If you want to make complaint or grievance in person, you may come to:

Empower Healthcare Solutions
1401 West Capitol Avenue, Suite 330
Little Rock, AR  72201

If you need help filing a complaint/grievance, Empower can help you. Just call 866-261-1286 | TTY: 711.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights on a computer through the Office for Civil Rights Complaint Portal, at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:

U.S. Department of Health and Human Services
200 Independence Avenue SW, Room 509F
HHH Building, Washington, DC 20201
800–868–1019, 800–537–7697 (TDD)

Copies of Complaint forms are at www.hhs.gov/ocr/office/file/index.html.

Appeals

If you do not agree with a decision we made about your services, you can ask for an appeal. You have 60 days from the date on the letter you receive saying your service was not approved to file an appeal. To ask for an appeal, you can call us at 866-261-1286 | TTY: 711. Oral appeal request must be followed with a written, signed appeal within ten (10) calendar days.  You can also send a letter to:

Empower Healthcare Solutions
P.O. Box 211446
Eagan, MN 55121

You may also ask for an appeal in person at:

Empower Healthcare Solutions
1401 West Capitol Avenue, Suite 330
Little Rock, AR  72201

After we receive your appeal, Empower will look at all of the information and decide within 30 days of when you tell us about it. We will send you a letter to tell you if the services will be approved.

If you believe that waiting 30 days for a decision on your appeal could be a risk to your health or ability to function, you can ask Empower for a faster decision. This is called an expedited appeal. Empower will decide about expedited appeals in seventy-two (72) hours.

If you need help with making an appeal, we have staff to help you. You can reach them by calling us at 866-261-1286 | TTY: 711.

If you ask, Empower must continue to provide you benefits during the appeal process. For that to happen, the following must happen:

  1. You or your parent/legal guardian request for appeal is timely in accordance with 42 CFR Part 438.420. Timely filing means within 10 days of receiving the denial or before the effective date of the services that were denied.
  2. The PASSE appeal involves the termination, suspension or reduction of previously authorized course of treatment;
  3. The services were ordered by an authorized provider;
  4. The period covered by the original authorization has not expired; and

You can receive benefits until one of these items occur:

  • You withdraw the appeal
  • You withdraw the request for benefits
  • You do not ask for a fair hearing and you don’t ask to extend benefits within 10 days of Empower sending you a notice that the appeal was not decided in your favor

Please note that if you do not win the appeal, you may have to pay for services received during the appeal process.

Also, you may request a fair hearing and a continuation of benefits if not satisfied with the outcome of your appeal. This request must be made within 10 days after the PASSE sends you the notice of appeal decision.