Grievance Process

Grievance & Appeals

We are providing you with information and forms for filing a grievance should you ever find that you are unhappy with the services you receive from Pride In North Carolina, Inc. or are concerned about a decision or action of a Pride In North Carolina, Inc. employee. While we hope you will be satisfied with the services you receive and find the staff to be professional and responsive, we want you to know that we very much want to know if you have a concern!

Download printable pdf of Appeal Form (9 KB)

Pride In North Carolina, Inc. Grievance Procedures

1. If there you have a concern, please bring it to the immediate supervisor or QP.
2. . If the concern is not resolved after discussing it with the supervisor or QP, then we ask that you complete Grievance / Appeal Report and submit it to the Regional Director or Program Coordinator. The Regional Director or Program Coordinator will meet with you and the supervisor within three working days.
3. The Regional Director or Program Coordinator will document his/her decision on the Grievance form and review it with you.
4. You will be asked to sign off on the form and indicate if you agree with the decision, or if you would like to appeal it. You will also have a space to make additional comments regarding the decision.
5. If you elect to appeal, the Regional Director / Program Coordinator will forward the report to the President within 24 hours.
6. The President will make a decision concerning the Grievance / Appeal Report within five working days of receipt. The President’s decision concerning the appeal will be forwarded back to the Regional Director or Program Coordinator.
7. The Regional Director or Program Coordinator will notify both you and the supervisor of the President’s decision.
8. The President may seek additional information from any source when rendering a decision. All decisions by the President are final.
9. Anyone who completes a Grievance or Appeal will be free from interference, coercion, discrimination, penalty, reprisal, or any action of retaliation or barriers to services.
10. If you would like an external review, Pride In North Carolina, Inc. staff will assist you in contacting any Advocacy Agency, Department of Social Services, or any other advocate that you choose.
11. All Grievance / Appeal Reports will be forwarded to the Human Rights Committee.

Medicaid Appeals

• Value Options is the organization that makes decisions about the type and amount of services you are allowed to receive from Medicaid.
• If Value Options decides to reduce or deny the services we request on your behalf, they are required to send you a letter explaining their decision, your appeal rights, and the appeal process.
• If you want to appeal their decision, you can do so by requesting an informal appeal which must be done within 11 days, or by requesting a formal appeal, which must be done within 60 days.
• If you do not do one of these two things by the 11th day, your services will be reduced or terminated based on the letter from Value Options.
• The form for requesting an appeal will be included with the Value Options Notification.

If your services are reduced or denied and you would like to appeal, WE WILL BE GLAD TO ASSIST YOU IN THE PROCESS!