Grievance Process
A grievance is a complaint, either written or oral, expressing dissatisfaction with service delivery or quality of care furnished by PACE Your LIFE or its contracted providers.
Any PACE Your LIFE participant or his/her representative may file a grievance with any staff member at any time either in person, by calling 302-865-3565, Toll Free: 1-833-722-3302, Fax: 302-265-2114, or in writing to PACE Your LIFE at the Milford Wellness Village, 21 West Clarke Ave., Suite 1010, Milford, DE 19963.
Any PACE Your LIFE participant or his/her representative may file a grievance with any staff member at any time either in person, by calling 302-865-3565, Toll Free: 1-833-722-3302, Fax: 302-265-2114, or in writing to PACE Your LIFE at the Milford Wellness Village, 21 West Clarke Ave., Suite 1010, Milford, DE 19963.
Appeals Process
An appeal is a participant’s action taken concerning the PACE Organizations: non-coverage of or non-payment of a service; a denial, reduction, or termination of an existing service; denial of a participant’s request for services or payment; involuntary disenrollment of a participant.
Any PACE Your LIFE participant has the right to file a verbal or written appeal by calling 302-865-3565, Toll Free: 1-833-722-3302, Fax: 302-265-2114, or in writing to PACE Your LIFE at the Milford Wellness Village, 21 West Clarke Ave., Suite 1010, Milford, DE 19963.
Any PACE Your LIFE participant has the right to file a verbal or written appeal by calling 302-865-3565, Toll Free: 1-833-722-3302, Fax: 302-265-2114, or in writing to PACE Your LIFE at the Milford Wellness Village, 21 West Clarke Ave., Suite 1010, Milford, DE 19963.
A Medicaid participant may make an external appeal within (30) calendar days of the notice of a denial. Information can be obtained by calling or writing:
Delaware Division of Medicaid and Medical Assistance
Herman M. Holloway Senior Health and Social Services Campus
1901 N. DuPont Highway New Castle, DE 19720
(302)255-9753
If you’d like someone other than yourself to file your appeal or grievance, organization determination, or coverage determination on your behalf, you must complete and turn in to us an appointed representative form at https:/www.cms.gov/cms1696-appointment-representative or a legal document stating you have chosen someone other than yourself to file for you. This will confirm that the individual has your permission to see all information including your medical records about the appeal and/or grievance.
Appointing a representative may be done at any point of the organization determination, coverage determination, or appeal or grievance process. You can appoint an attorney, or another individual, to help you and to act as your representative. An appointment of representative form, or the same request in a written request, will need to be completed by the person making the appointment. If using a written request, it must include all of the same information requested on the appointment of representative form. This appointment of a representative will expire one year from the signing date on the appointment form or written document of both you and the individual you are appointing.
Appointing a representative may be done at any point of the organization determination, coverage determination, or appeal or grievance process. You can appoint an attorney, or another individual, to help you and to act as your representative. An appointment of representative form, or the same request in a written request, will need to be completed by the person making the appointment. If using a written request, it must include all of the same information requested on the appointment of representative form. This appointment of a representative will expire one year from the signing date on the appointment form or written document of both you and the individual you are appointing.