Privacy Forms
Access Request Form
Accounting Request Form
Amendment Request Form
Notice of Privacy Practices
Mailing
Restriction Request Form
Release of Information form
How to Appoint a Representative
Enrollee Rights and Responsibilities
Grievance, Appeals, and Exceptions
PrimeTime Health Plan maintains information on the number of Grievances, Appeals and Exceptions that are made against us. This information can be obtained by writing to PrimeTime Health Plan and mailing to P.O. Box 6029, Canton, OH 44706.
If you need to file a grievance, you may call PrimeTime Member Services by dialing 1-800-577-5084 (toll free) or 330-363-7407 (local calls). Our TTY phone number for the hearing impaired is toll free 1-800-617-7446. You may fax your Grievance to 330-363-3066. You may also write in to file a grievance to P.O. Box 6029, Canton, OH 44706.
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