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Compliance
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Effective Date: August 1, 2024
Last Reviewed On: August 1, 2024
Last Reviewed On: August 1, 2024
Hello Heart’s Medicare Advantage Grievance Policy
A grievance is any complaint other than one that involves a coverage determination with your plan. A grievance can be about issues you have with our service or Hello Heart employees such as:
- The quality of your service; experience with our product or services.
- Unprofessional or offensive behavior experienced with a Hello Heart employee.
- Not being able to reach customer support by phone during normal business hours (Monday to Friday, 8AM - 8PM Eastern, excluding Federal Holidays).
- Obtaining the information you need.
You and or your representative may file a grievance no later than 60 days after the event or incident that caused the grievance. All grievances can be filed by email, by phone, or by writing to:
Hello Heart
Attn: Customer Support
Address: 545 Middlefield Road, Suite 260, Menlo Park, CA 94025
Phone: (800) 767-3471
Email: support@helloheart.com
Hello Heart
Attn: Customer Support
Address: 545 Middlefield Road, Suite 260, Menlo Park, CA 94025
Phone: (800) 767-3471
Email: support@helloheart.com
Medicare Advantage hotline
You can also file a grievance directly with your Medicare Advantage plan or by contacting Medicare directly at 1-800-MEDICARE, 24 hours a day, 7 days a week, except some federal holidays. TTY users can call 1-877-486-2048.
Grievances submitted orally may be answered either orally or in writing via email communication unless you ask for a written response.
Hello Heart will provide you a response as quickly as possible, but no later than 30 days after the date we receive your grievance.
Grievances submitted orally may be answered either orally or in writing via email communication unless you ask for a written response.
Hello Heart will provide you a response as quickly as possible, but no later than 30 days after the date we receive your grievance.
Fraud, Waste, and Abuse (FWA)
What is fraud, waste, and abuse?
Fraud is an intentional or deliberate act to deprive another of property or money by deception or other unfair means. The ways in which fraud occurs are as unique as the individual perpetrators, their motives, and the situations they exploit.
Waste includes practices that, directly or indirectly, result in unnecessary costs to federally funded programs, such as overusing services. Waste is generally not considered to be caused by criminally negligent actions but rather by the misuse of resources.
Abuse includes actions that may, directly or indirectly, result in unnecessary costs to federally funded programs. Abuse involves paying for items or services when there is no legal entitlement to that payment.
Waste includes practices that, directly or indirectly, result in unnecessary costs to federally funded programs, such as overusing services. Waste is generally not considered to be caused by criminally negligent actions but rather by the misuse of resources.
Abuse includes actions that may, directly or indirectly, result in unnecessary costs to federally funded programs. Abuse involves paying for items or services when there is no legal entitlement to that payment.
Help us by reporting concerns of fraud, waste, and abuse.
If you have a compliance concern or suspect fraud, waste, or abuse, please contact our Compliance Hotline at 1-866-566-6057 (TTY 711), available 24/7, or via the online reporting portal. You can report your concerns confidentially and anonymously if you choose.
