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Veterans Affairs Community Care Program Complaints/Grievances

Any Veteran who has been referred by his/her Department of Veterans Affairs (VA) provider to a Community Care program contracted network provider can submit a complaint/grievance to TriWest’s Congressional Relations & Customer Grievances department.

The complaint/grievance process allows the Veteran (or an authorized representative of the Veteran) to submit a written complaint/grievance regarding the quality of services received by the Veteran during a network care visit or any other issue related to service provided under the Community Care program.

Veterans who are unable to provide a formal complaint/grievance in writing may do so verbally to a VA or TriWest representative for submission via a written communication (email or complaint form). Such cases will be worked in the same fashion as all other formal complaints and grievances.

The types of issues that are investigated in the complaint/grievance process include the failure or perceived failure of TriWest staff or a Community Care Program network provider (including members of the provider’s staff) to ensure:

  • Quality care
  • Timely care
  • Appropriate care
  • Continuity of care
  • Follow-up care
  • Practices that ensure patient safety
  • Practices that ensure patient privacy
  • Practices that ensure clear/understandable communication between provider and patient
  • Practices for treating patients with dignity, respect and understanding (not being rude or confrontational)
  • Reasonable waiting periods in a provider’s office
  • Provider office or facility cleanliness, condition or state-of-repair
  • Reasonable access to care in terms of travel times and distances from home
  • An expected level of customer service
  • The timely transfer of medical records from Community Care program network providers to the referring VA medical facility
  • The timely processing of Communiy Care program-contracted network provider requests for additional specialty care services or tests needed to properly diagnose and/or treat the Veteran

The written complaint/grievance should include the following:

  • Veteran’s name, address, telephone number and email address
  • Name, address, telephone number and email address of any person representing the Veteran and information regarding the representative’s relationship to Veteran (i.e., grandparent, parent, sibling, spouse, significant other, adult child, friend, court-appointed guardian, etc.)
  • Last four digits of Veteran’s Social Security number
  • Veteran’s date of birth
  • A description of the issue or concern that must include:
    • Date and time of the event or incident
    • Name(s) of the provider(s) and/or person(s) involved
    • Location of the event or incident (address)
    • Nature of the concern or complaint
    • Details describing the event or issue
    • Any appropriate supporting documents
    • Veteran’s signature
    • If an authorized representative submits a complaint/grievance on behalf of the Veteran, a written authorization signed by the Veteran must be included with the complaint/grievance submission. The signed document must include information that fully identifies the appointed representative and how long the authorization is to remain in effect (i.e., an authorization termination date).
    • If the Veteran is not able to handle his or her own affairs due to disability, the complaint/grievance submission must include a Power of Attorney or other court document (i.e., appointment of guardianship) authorizing the representative to act on the Veteran’s behalf.

A Community Care Program Complaint/Grievance Form can be accessed by visiting Forms. Please note that this form cannot be sent via email. It must be filled out, printed and submitted via U.S. mail or fax. Due to personally identifiable information (PII) and protected health information (PHI) concerns, there is no option available for submitting this form electronically online.

Written complaints/grievances should be mailed to:

TriWest Healthcare Alliance
Congressional Relations & Customer Grievances
P.O. Box 41970
Phoenix, AZ 85080-1970

Written complaints/grievances can be faxed to:

TriWest Healthcare Alliance
Congressional Relations & Customer Grievances
Fax: (602) 564-2523

Important Note: To ensure protection against any potential compromise of PII or PHI, TriWest strongly discourages sending complaints/grievances via .pdf or .tiff attachments to an email or via information contained within an email sent to any published TriWest staff or department email addresses.

Updated: 9/20/2021 9:53:10 AM