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

COMPLAINT, GRIEVANCE AND APPEAL PROCEDURES. We want to know when You are dissatisfied about the care or services received from Blue Cross and Blue Shield of Louisiana, United Concordia Dental (UCD), or Participating Providers. If You want to register a Complaint or file a formal written Grievance about Us, UCD or a Provider, please refer to the procedures below. You may be dissatisfied about decisions made regarding Covered Services. UCD considers an Appeal as Your written request to change an Adverse Benefit Determination. Your Appeal rights are outlined below, after the Complaint and Grievance procedures. There is an Expedited Appeals process for situations where the time frame of the standard Dental Necessity Appeal 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 You are dissatisfied unhappy about the care or services received from Blue Cross and Blue Shield of Louisiana, United Concordia Dental (UCD), or Participating Providers. If You want a Member wants to register a Complaint or file a formal written Grievance about Us, UCD or a Provider, please refer to the procedures below. You A Member may be dissatisfied unhappy about decisions made regarding Covered Services. UCD considers an Appeal as Your the Member’s written request to change an Adverse Benefit Determination. Your Appeal rights are outlined below, after the Complaint and Grievance procedures. There is an Expedited Appeals process for situations where the time frame of the standard Dental Necessity Appeal would seriously jeopardize the life or health of a covered person or would jeopardize the covered person’s ability to regain maximum function.