Managed Care

Kentucky

Summit’s managed-care system is designed to provide you with quality medical care from doctors who specialize in workplace injuries. Managed care simply means that someone, usually a primary care physician, will manage your care. In other words, this person will decide whether you need to return for additional treatment, see a specialist, have therapy, etc.

As part of our managed care plan, we have a network of thousands of doctors and facilities, including hospitals, walk-in clinics and specialists, all dedicated to helping you heal quickly and return to work as soon as possible.

Grievance Procedures

If you’re dissatisfied with your medical care, we want to know, and we want to help. Please speak with your medical care coordinator or a claims supervisor if you need to request a medical service or have any questions about your care. If, after speaking with the appropriate member of our staff, you are still not satisfied, you may file a grievance.

What is a grievance?

A grievance is a formal way to express your dissatisfaction with your medical care. It is a serious matter, and should not be taken lightly by anyone involved in your claim.

How to file a grievance

  • All grievance requests must be in writing. To help you file your grievance, you may use our Grievance Review Request form. Please complete this form and mail it to the following address:
    Summit Claims Center
    Attn: Summit MCA Grievance Coordinator
    P.O. Box 600
    Gainesville, GA 30503-0600
  • All grievances must be filed within 30 days of the occurrence.
  • Your grievance form must include: (1) a summary of the issues, including all specifics, such as names, dates and origin of the issue; (2) a clear explanation of how you want the situation resolved; and (3) all supporting documentation for each issue.
  • Once we receive your grievance form, we will gather and review the applicable medical information. In most cases, we will make an initial determination on either granting or denying it within 30 calendar days of receipt.
  • If a grievance involves the collection of information outside the service area, and all parties agree, the 30-day time frame may be extended.
  • If your are dissatisfied with the outcome of the grievance process, you may apply for review by an administrative law judge. To do this you must file a request for resolution within 30 days of the date of our final decision. If you file a request for resolution, it is your responsibility to prove that our final decision is unreasonable.

Back to Top