Grievances and Appeals
If you are having issues with the behavioral health services you are receiving through North Sound BH-ASO, you have the right to file a grievance. A “grievance” means an expression of dissatisfaction about any matter other than an action. Possible subjects for grievances may include but are not limited to, the quality of care or services provided, aspects of interpersonal relationships such as rudeness of a provider or employee, or failure to respect your individual rights. You may file a grievance directly with North Sound BH-ASO or contact the Office of Behavioral Health Advocacy (OBHA), formerly Ombuds, for assistance.
An “appeal” is a request for the review of an action. An “action” is a denial or the limited authorization of North Sound BH-ASO services based on a medical necessity decision. If North Sound BH-ASO sends you a denial of services only based on medical necessity, you have the right to file an appeal. The appeal is a review of the denial by the North Sound BH-ASO Medical Director for which there are two outcomes, uphold the denial or overturn the denial. You may file the appeal directly with North Sound BH-ASO or contact the OBHA for assistance.
If you are an individual who has Medicaid and is seeking assistance in filing a grievance or appeal, please contact your Medicaid Apple Health Plan. You may also contact the OBHA for assistance in filing with your Medicaid Apple Health Plan.