To file a formal Grievance with PBH you can click here to access, download and print the online forms or contact the following and ask for the forms to be sent to you, or you can file a verbal grievance. If you want to be contacted or receive a form, be sure to leave your address and phone number:

Concern Line		Office of Consumer Affairs	704-721-7007
Access/Help Line	800-939-5911	Quality Management	704-721-7000

You can file a Grievance anonymously by clicking here. Any PBH employee can take your Grievance.

If you fill out a Grievance Form, sign and date the Authorization for the Release of Healthcare Information forms and have someone you know witness your signature by having the witness sign and date the form as well. A separate original signed release is needed for each agency or hospital that PBH will need to contact or request records from in order to investigate your grievance.

Once your Grievance Form is received, every effort will be made to resolve your complaint within 30 days. If you are dissatisfied with how your grievance was resolved, you can file a written Formal Review Request within 15 days. A Formal Review Form can be downloaded here or requested from the Office of Consumer Affairs or Quality Management.

A Unit Manager, who will respond to you within 15 days, will investigate your Formal Review. If you are still dissatisfied send your original Formal Review form along with a written request for a Second Level Formal Review to the Director of Quality Management within 15 days. The Director of Quality Management and the Unit Director will then review it and the Director of Quality Management will notify you of the decision within 15 calendar days of receipt of your request for a Second Level Formal Review. If you do not agree with the decision, you can do the following:

	Resubmit your grievance to the Chief Executive Officer (CEO) of PBH, within 15 days of receiving the decision from the Director of Quality Management. The CEO will review your grievance and contact you with a decision within 15 days.
	At any time you have the right to bypass local consideration and call Disability Rights North Carolina (DRNC) at 1-877-235-4210.
	Not a Medicaid beneficiary? You can still file a grievance or call Disability Rights North Carolina (DRNC) at 1-877-235-4210.

If you want to ask for a reconsideration of a notice to deny, reduce, suspend or end a Medicaid service, call Utilization Management at 704-743-2100.

If you have any questions or need help filling out forms, feel free to email or call Bonnie at 704-721-7007, or Carol at 704-721-7018