The grievance and appeals process is intended to provide a reasonable opportunity for a full and fair review of an adverse determination. The process varies slightly based on Federal and State regulations.
- For Commercial Members - Section 4.12 Utilization Review Appeals and Grievances
- For Medicare Members - Section 9.5 Member Grievances, Organization Determinations and Appeals
- For Medicaid Members - Section 10.11 Member Grievance and Utilization Review Appeal Policy and Procedure