NEED TO MAKE A COMPLAINT AOUT YOUR CARE?

WHAT IS AN APPEAL?
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If you are not happy with the care that you are getting, call your Insurer at 1-844-336-3331 (toll free), TTY 787-999-4411 (for the hearing impaired). Tell them that you need to make a complaint. You can also visit your Insurer’s Service Centers. You can make a complaint at any time.

Your doctor, a family member, or your representative can make a complaint for you if you authorize them to do so.

You also have the right to call the Patient Advocate Office to make a complaint. Their number is 1-800-981-0031. You can also make a complaint to ASES. Their number is 1-800-981-2737.

No one can do anything bad to you if you make a complaint.

Your Insurer has 72 hours to fix your complaint. If they can’t fix your complaint quickly, it will become a “grievance”. In this case, your Insurer has up to 90 days to fix it, but they have to decide faster if it’s important to your health. The Insurer must tell you how the complaint was fixed. 

What happens if my complaint isn’t fixed?

If your Insurer does not fix your complaint, you can ask for a hearing. A hearing is where you can tell a judge about the issue.
 
 

Enrollee Services
1-844-336-3331 (toll free)
787-999-4411 TTY (hearing impaired)
Monday through Friday
from 7:00 a.m. to 7:00 p.m.
Multilanguage Services

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PO BOX 72010
San Juan, PR 00936-7710

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Fundación Angel Ramos Anexo, 2do piso Ave. Chardón, Hato Rey, PR

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