Beneficiary Grievances. APS PR and APS PR Providers agree to be governed and abide by Humana PR's grievance policies and procedures and the Health Insurance Contract's grievance procedure unless such procedures are preempted by any duly enacted law or regulation promulgated by ASES or any other governmental agency or department with jurisdiction over the parties. APS PR and APS PR Provider shall cooperate with Humana PR in resolving any Beneficiary grievances related to the provision of services to Beneficiaries. In this regard, APS PR and APS PR Providers agree to notify Humana PR within 5 business days whenever a Beneficiary files an informal or formal complaint or grievance, or legal action, against APS PR or an APS PR Provider. APS PR and APS PR Providers shall make every reasonable effort to promptly resolve any informal or formal complaint or grievance within 5 days. APS PR and APS PR Providers shall refer Beneficiaries who have complaints regarding health services, provider relations, benefits, or any other aspect of service to Humana PR's Member/Beneficiary Services Department. APS PR and the affected APS PR Provider shall cooperate with Humana PR in the investigation of any complaint, grievance or legal action, in accordance with Humana PR's grievance procedures. Upon request by Humana PR, APS PR and APS PR Provider shall provide full details of the nature, circumstances and disposition of any such complaint, grievance or legal action to Humana PR or its legal representative. APS PR and APS PR Provider agree to comply with and be bound in the disposition of all grievances or complaints, by the Health Insurance Contract grievance procedure.
Beneficiary Grievances
