In making a decision about authorizing behavioral health care, the only factors Concordia considers are whether the care or service is appropriate and whether coverage exists for the care or service. Concordia never rewards practitioners or other individuals involved in making decisions for denying care or service. There are no financial incentives for any Concordia employee or representative that would encourage underutilization of behavioral health care or services.
Communicating with Concordia
Concordia Behavioral Health (Concordia) staff may be contacted toll-free at 1-855-514-5300 during the hours of 8:30 a.m. to 5:00 p.m. We will also accept collect calls during these hours. Should you need to speak to someone after this time, Concordia also has after-hours physicians available to discuss any questions or concerns related to a UM case or decision. If you require assistance through a bilingual staff member or an interpreter, Concordia can provide language assistance free of charge to the member. Should you require TDD/TTY services please contact us at 305.514.5399, or toll free at 855-276-7285.
What to Do If You Disagree With a Decision
Concordia Behavioral Health uses a team of behavioral health care professionals to ensure that members get the treatment they need and that it is consistent with their health insurance benefits. Occasionally, you may disagree with our decisions. Concordia has an appeals process that can be used if you believe we have not made the correct decision. All appeals are reviewed by psychiatrists or other doctoral level behavioral health clinicians who were not involved in the original decision. In addition to this internal appeals process, you have the right to appeal decisions to an external review body. In the State of Florida, the Agency for Health Care Administration (AHCA) conducts external appeals.
Grievances are written complaints made by a subscriber, dependent, and/or guardian regarding Concordia’s quality of service, quality of care, access or availability, provisions of services, and claims administration. A grievance may also include a complaint related to an adverse determination made pursuant upon utilization review.
Concordia has a TTY line available for the hearing impaired.
Concordia’s values and expectations for continuity and coordination between the healthcare and behavioral healthcare delivery systems.