MEMBER COMPLAINTS, GRIEVANCES AND APPEALS Sample Clauses

MEMBER COMPLAINTS, GRIEVANCES AND APPEALS. 8.1 Where necessary, Xxxxx or Plan(s) will provide or make available to Provider, any information regarding relevant administrative requirements to be used in connection with or applicable to Member complaint or grievance processes.
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MEMBER COMPLAINTS, GRIEVANCES AND APPEALS. The Contractor shall have in place a written Grievance and Appeal System that defines Members’ rights regarding disputed matters with the Contractor. The Contractor’s Grievance and Appeal System shall include a complaints process (the procedures for addressing member complaints that are not appeals or grievances), an appeals process, and an SMI appeals and grievance process. The Contractor shall work with each Member to attempt resolution of disputes at the lowest level possible.
MEMBER COMPLAINTS, GRIEVANCES AND APPEALS. 1. The TRBHA will ensure that Members are aware of their rights and how to file a complaint, grievance and/or appeal.

Related to MEMBER COMPLAINTS, GRIEVANCES AND APPEALS

  • Grievances and Appeals a. If you have questions about any pediatric dental services received, please first discuss the matter with your Dental Provider. However, if you continue to have concerns, please call Delta Dental’s Customer Service Center. You can also email questions by accessing the “Contact Us” section of the dental plan website at xxx.xxxxxxxxxxxxxx.xxx.

  • Grievances and Complaints 5.1 It is the mutual desire of the parties hereto that grievances and complaints relative to this Agreement or working conditions generally shall be adjusted as quickly as possible.

  • COMPLAINTS AND APPEALS As a Premera member, you have the right to offer your ideas, ask questions, voice complaints and request a formal appeal to reconsider decisions we have made. Our goal is to listen to your concerns and improve our service to you. If you need an interpreter to help with oral translation, please call us. Customer Service will be able to guide you through the service. WHEN YOU HAVE IDEAS We would like to hear from you. If you have an idea, suggestion, or opinion, please let us know. You can contact us at the addresses and telephone numbers found on the back cover. WHEN YOU HAVE QUESTIONS Please call us when you have questions about a benefit or coverage decision, our services, or the quality or availability of a healthcare service. We can quickly and informally correct errors, clarify benefits, or take steps to improve our service. We suggest that you call your provider of care when you have questions about the healthcare they provide.

  • Investigation of Grievances The investigation of grievances shall not interfere with the orderly process of education in District 281.

  • Grievance and Appeals Unit See Section 9 for contact information. You may also contact the Office of the Health Insurance Commissioner’s Consumer Resource Program, RIREACH at 1-855-747-3224 about questions or concerns you may have. Complaints A complaint is an expression of dissatisfaction with any aspect of our operation or the quality of care you received from a healthcare provider. A complaint is not an appeal. For information about submitting an appeal, please see the Reconsiderations and Appeals section below. We encourage you to discuss any concerns or issues you may have about any aspect of your medical treatment with the healthcare provider that furnished the care. In most cases, issues can be more easily resolved if they are raised when they occur. However, if you remain dissatisfied or prefer not to take up the issue with your provider, you can call our Customer Service Department for further assistance. You may also call our Customer Service Department if you are dissatisfied with any aspect of our operation. If the concern or issue is not resolved to your satisfaction, you may file a verbal or written complaint with our Grievance and Appeals Unit. We will acknowledge receipt of your complaint or administrative appeal within ten (10) business days. The Grievance and Appeals Unit will conduct a thorough review of your complaint and respond within thirty (30) calendar days of the date it was received. The determination letter will provide you with the rationale for our response as well as information on any possible next steps available to you. When filing a complaint, please provide the following information: • your name, address, member ID number; • the date of the incident or service; • summary of the issue; • any previous contact with BCBSRI concerning the issue; • a brief description of the relief or solution you are seeking; and • additional information such as referral forms, claims, or any other documentation that you would like us to review. Please send all information to the address listed on the Contact Information section.

  • Disciplinary Grievances If the grievance is not resolved at Step 2, the Union may file a request for mediation with the Public Employment Relations Commission (PERC) in accordance with WAC 000-00-000, with a copy to the Office of Financial Management/SHR/Labor Relations Section (OFM/SHR/LRS) and the Human Resources Office within fifteen (15) days of receipt of the Step 2 decision. In addition to all other filing requirements, the request must include a copy of the grievance and all previous responses.

  • COMPLAINT AND GRIEVANCE PROCEDURE 1. When a member of the bargaining unit has any grievance or complaint, he shall forthwith convey to his immediate superior, orally with or without a member of the Association Executive or in writing, all facts relative to the grievance and/or complaint. The member and the superior shall make every attempt to resolve the problem at this preliminary stage.

  • Policy Grievance – Employer Grievance The Employer may institute a grievance alleging a general misinterpretation or violation by the Union or any employee by filing a written grievance with the Bargaining Unit President, with a copy to the Labour Relations Officer within twenty (20) days after the circumstances have occurred. A meeting will be held between the parties within ten (10) days. The Union shall reply within ten (10) days after the meeting, and failing settlement, the matter may be referred to arbitration.

  • COMPLAINTS AND GRIEVANCES 22.01 It is the mutual desire of the parties to this Agreement that reasonable and legitimate complaints and grievances of employees shall be dealt with as quickly as possible.

  • Disciplinary Grievance If a grievance alleging that a disciplinary action (reduction in base pay, demotion, involuntary transfer of more than 50 miles by highway, suspension, or dismissal) was taken without cause is not resolved at Step 2, the PBA may appeal the grievance to arbitration within 15 days after receipt of the decision at Step 2, provided the Step 2 decision is received on or before the due date.

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