Grievance

A grievance is a complaint to an HMO by a member or provider about an action or decision. Decisions regarding the medical necessity of a service are not considered grievances. They are handled as utilization review appeals. (See utilization review appeal.)

See Also: Dental Care; External Appeal/External Review; First-level Internal Appeal Process; Fee-for-Service;

Get our Quick Quotes: Auto Quick Quote Home Quick Quote Life Quick Quote Health Quick Quote and Apply Online Travel Quick Quote and Purchase Online Insurance in California