Complaints Against HICAP

Purpose

To establish a process for handling complaints against the Health Insurance Counseling and Advocacy Program (HICAP), its staff, and volunteers. It is possible that complaints will be received from clients, insurance agents, and/or other individuals who may directly or indirectly be affected by HICAP actions and activities.

Policy

Every attempt should be made to resolve complaints locally at the Program level. Complaints which can be resolved simply and quickly should be handled informally either by telephone or personal contact with the Program Manager. A complaint which cannot be resolved locally must be submitted in writing to initiate the formal complaint process. This section defines the formal complaint process.

Procedure

Complaint Against HICAP Definition – a complaint is an expression of dissatisfaction, resentment, discontent, or grievance. Any formal or informal complaint registered about HICAP services by a member of the public is a complaint against HICAP. All complaints should be given serious and immediate attention.
Complaints against HICAP may be generated by:
  • A client or their representative who is dissatisfied with access to services or the quality of service received by the HICAP;
  • Another department, program, agency, or organization which is dissatisfied with the activities of the HICAP;
  • An insurance agent who feels the counseling services provided by HICAP have impacted his/her business activities in a negative or unfair manner; or
  • A HICAP counselor or counselor applicant who has a complaint regarding the local HICAP.
A client or his/her representative may file a verbal or written complaint against HICAP, an employee, or volunteer for the following reasons:
  • Amount or duration of HICAP services
  • Denial or discontinuation of HICAP services
  • Dissatisfaction with the service provided or with the HICAP service provider or employee
  • Failure of HICAP to comply with any of the program requirements
Complaints should be filed with the Program Manager within 90 days of occurrence. The Program Manager shall review the complaint and transmit his/her findings(s) to the complainant within 30 days of receiving the complaint. The complainant may appeal to the local Area Agency on Aging (AAA), if dissatisfied with the finding(s) of the HICAP Program Manager. Such appeal shall follow the grievance process of the Orange County AAA, included as Exhibit A.
There may be occasions when the Program Manager is certain a complaint is a form of harassment because of an action taken by HICAP. If this occurs, the Council on Aging – Southern California and AAA will be immediately notified. The California Department of Aging (CDA) will provide technical assistance as needed.
HICAP shall abide by all confidentiality requirements while responding to a complaint against HICAP.
All complaints, investigations, findings, and responses shall be filed and maintained by the local HICAP and AAA offices. Files shall be maintained until an audit or audit resolution has occurred within the AAA.
Exhibit A | Grievance Procedure
SHIP State Insurance Assistance Program

This project was supported, in part, by grant number 90SAPG0052-03-00 from the U.S. Administration for Community Living, Department of Health and Human Services, Washington D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy.

This project is funded in part through a grant from the California Department of Aging, as allocated by the Orange County Board of Supervisors and administered by the Office on Aging.