Grievance Decision. If you have received an adverse decision, you, your representative, or your health care provider on your behalf, have the right to file a grievance with us. The following conditions apply to grievance filings: • The adverse decision grievance must be filed by you, your representative, or your health care provider on your behalf, with us within 180 calendar days of receipt of our adverse decision. • For prospective denials (denials on health services that have not yet been rendered), we will render a grievance decision in writing within 30 calendar days after the filing date, unless it involves an emergency case as explained below. The “filing date” is the earlier of five days after the date the grievance was mailed or the date of receipt. Unless written permission has been given, you, your representative, or your health care provider on your behalf, have the right to file a complaint with the Insurance Commissioner, if you have not received our grievance decision on or before the 30th calendar day after the filing date. • For retrospective denials (denials on health services that have already been rendered), we will render a grievance decision within 45 calendar days after the filing date. Unless written permission has been given, you, your representative, or your health care provider on your behalf, have the right to file a complaint with the Insurance Commissioner (see below), if you have not received our grievance decision on or before the 45th calendar day after the filing date. • With written permission from you, your representative, or your health care provider on your behalf, the time frame within which we must respond can be extended up to an additional 30 business days. • If we need additional information in order to review the case, we will notify you, your representative and/or your health care provider within five business days after the filing date. We will assist you, your representative, or the health care provider in gathering the necessary medical records without further delay. If no additional information is available or is not submitted to us, we will render a decision based on the available information. • Except as described under the first two bullets in the Complaints provision above, for retrospective denials, you, your representative, or your health care provider on your behalf, must file a grievance with us before filing a complaint with the Insurance Commissioner, as described below. • Notice of our grievance decision will be verb...
Grievance Decision. 11. Health Education and Advocacy Unit; 12. Health Care Provider;
Grievance Decision. The deciding official will issue a written decision within fifteen (15) workdays after the date of the grievance conference if a meeting was held or within twenty (20) workdays after receipt of the grievance if no meeting was held. The decision shall meet the requirements of Section 9.
Grievance Decision. The Labor Relations Representative will render a decision on a grievance appealed to Step 2 as soon as possible but not later than five (5) working days, excluding Saturdays, Sundays, and holidays (unless extended by mutual agreement) after their meeting with the Business Agent on such grievances.
Grievance Decision. If a Decision is not received within 30 days of the transmittal of the Step 1 Grievance, the grievant may file a Step 2 Grievance within 30 days of when the Step 1 Decision was due.
Grievance Decision. All grievance decisions will be in writing and state the issue being grieved, a summary of the findings and the rationale for the decision. Copies of relevant documents cited in the decision will be provided if they are not otherwise readily available to the employee.
