Common use of COMPLAINT, GRIEVANCE AND APPEAL PROCEDURES Clause in Contracts

COMPLAINT, GRIEVANCE AND APPEAL PROCEDURES. ‌‌‌‌ We want to know when a Member is dissatisfied about the care or services he receives from Blue Cross and Blue Shield of Louisiana or one of Our Providers. If a Member wants to register a Complaint or file a formal written Grievance about Us or a Provider, please refer to the procedures below. A Member may be dissatisfied about decisions We make regarding Covered Services. We consider an Appeal as the Member’s request to change an Adverse Benefit Determination made by the Company. Your Appeal rights are outlined below, after the Complaint and Grievance procedure. In addition to the Appeals rights, the Member’s Provider is given an opportunity to speak with a Medical Director for an Informal Reconsideration of Our coverage decision when they concern Medical Necessity determinations. We have expedited Appeals processes for situations where the time frame of the standard medical Appeals would seriously jeopardize the life or health of a covered person or would jeopardize the covered person’s ability to regain maximum function.

COMPLAINT, GRIEVANCE AND APPEAL PROCEDURES. ‌‌‌‌ We want to know when a Member is dissatisfied about the care or services he receives from Blue Cross and Blue Shield of Louisiana or one of Our Providers. If a Member wants to register a Complaint or file a formal written Grievance about Us or a Provider, please refer to the procedures below. A Member may be dissatisfied about decisions We make regarding Covered Services. We consider an Appeal as the Member’s request to change an Adverse Benefit Determination made by the Company. Your Appeal rights are outlined below, after the Complaint and Grievance procedure. In addition to the Appeals rights, the Member’s Provider is given an opportunity to speak with a Medical Director for an Informal Reconsideration of Our coverage decision when they concern Medical Necessity determinations. We have expedited Appeals processes for situations where the time frame of the standard medical Appeals would seriously jeopardize the life or health of a covered person or would jeopardize the covered person’s ability to regain maximum function.

COMPLAINT, GRIEVANCE AND APPEAL PROCEDURES. ‌‌‌‌ We want to know when a Member is dissatisfied unhappy about the care or services he receives received from Blue Cross and Blue Shield of Louisiana or one of Our Providers. If a Member wants to register a Complaint or file a formal written Grievance about Us or a Provider, please refer to the procedures below. A Member may be dissatisfied unhappy about decisions We make regarding Covered Services. We consider an a written Appeal as the Member’s request to change an Adverse Benefit Determination made by the Company. Your Appeal rights are outlined below, after the Complaint and Grievance procedureProcedures. In addition to the medical Appeals rights, the Member’s Provider is given an opportunity to speak with a Medical Director for an Informal Reconsideration of Our coverage decision when they concern Medical Necessity determinations. We have expedited Appeals Appeal processes for situations where the time frame of the standard medical Appeals would seriously jeopardize the life or health of a covered person person, or would jeopardize the covered person’s ability to regain maximum function.

COMPLAINT, GRIEVANCE AND APPEAL PROCEDURES. ‌‌‌‌ We want to know when a Member is dissatisfied unhappy about the care or services he receives received from Blue Cross and Blue Shield of Louisiana or one of Our Providers. If a Member wants to register a Complaint or file a formal written Grievance about Us or a Provider, please refer to the procedures below. A Member may be dissatisfied unhappy about decisions We make regarding Covered Services. We consider an a written Appeal as the Member’s request to change an Adverse Benefit Determination made by the Company. Company.‌ Your Appeal rights are outlined below, after the Complaint and Grievance procedureProcedures. In addition to the medical Appeals rights, the Member’s Provider is given an opportunity to speak with a Medical Director for an Informal Reconsideration of Our coverage decision when they concern Medical Necessity determinations. We have expedited Appeals Appeal processes for situations where the time frame of the standard medical Appeals would seriously jeopardize the life or health of a covered person person, or would jeopardize the covered person’s ability to regain maximum function.