APPEAL AND GRIEVANCE

• What is the appeals/grievance process?

Tip: Every plan is required to have a clear appeals process for members to appeal a managed care plan’s decision to limit or deny coverage for care. Health plans are also required to have grievance systems, if you have concerns about other aspects of the health plan’s operation (such as the quality of care you are receiving, or problems obtaining reimbursement for health care bills that you paid). Find out how the appeals and grievances processes work.

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