Common use of COMPLAINTS AND APPEALS Clause in Contracts

COMPLAINTS AND APPEALS. HMO has procedures for Members to use if they are dissatisfied with a decision that the HMO has made or with the operation of the HMO. The procedure the Member needs to follow will depend on the type of issue or problem the Member has. • Appeal. An Appeal is a request to the HMO to reconsider an adverse benefit determination. The Appeal procedure for an adverse benefit determination has two levels. • Complaint. A Complaint is an expression of dissatisfaction about quality of care or the operation of the HMO.

COMPLAINTS AND APPEALS. HMO has procedures for Members to use if they are dissatisfied with a decision that the HMO has made or with the operation of the HMO. The procedure the Member needs to follow will depend on the type of issue or problem the Member has. • Appeal. An Appeal is a request to the HMO to reconsider an adverse benefit determination. The Appeal procedure for an adverse benefit determination has two levelslevel(s). • Complaint. A Complaint is an expression of dissatisfaction about the quality of care or the operation of the HMO.

COMPLAINTS AND APPEALS. HMO has procedures for Members to use if they are dissatisfied with a decision that the HMO has made or with the operation of the HMO. The procedure the Member needs to follow will depend on the type of issue or problem the Member has. • Appeal. An Appeal is a request to the HMO to reconsider an adverse benefit determination. The Appeal procedure for an adverse benefit determination has two levels. • Complaint. A Complaint is an expression of dissatisfaction about the quality of care or the operation of the HMO.

COMPLAINTS AND APPEALS. HMO has procedures for Members to use if they are dissatisfied with a decision that the HMO has made or with the operation of the HMO. The procedure the Member needs to follow will depend on the type of issue or problem the Member has. If the state of Washington requirements are more beneficial to the Member, the state requirements govern. • Appeal. An Appeal is a request to the HMO to reconsider an adverse benefit determination. The Appeal procedure for an adverse benefit determination has two levelsone level. • Complaint. A Complaint is an expression of dissatisfaction about quality of care or the operation of the HMO.

COMPLAINTS AND APPEALS. HMO has procedures for Members to use if they are dissatisfied with a decision that the HMO has made or with the operation of the HMO. The procedure the Member needs to follow will depend on the type of issue or problem the Member has. • Appeal. An Appeal is a request to the HMO to reconsider an adverse benefit determination. The Appeal procedure for an adverse benefit determination has one or two levels, depending on the reason for the adverse benefit determination. • Complaint. A Complaint is an expression of dissatisfaction about quality of care or the operation of the HMO.