Member Grievance. A Member grievance is a claim initiated by the Association on behalf of an individual Member based on a dispute or difference arising out of the interpretation, application, administration or alleged violation(s) of the provisions of the Collective Agreement that solely affects the Member.
Member Grievance. An expression of dissatisfaction, regardless of whether identified as a “Grievance,” received by any employee of the Contractor orally or in writing about any matter or aspect of the Contractor or its operation, other than a Adverse Benefit Determination. Member Grievances may include but are not limited to the quality of care or services provided, and aspects of interpersonal relationships such as rudeness of a provider or employee, or failure to respect the enrollee’s rights regardless of whether remedial action is requested. Grievance includes but is not limited to an enrollee’s right to dispute an extension of time proposed by the MCO, PIHP, or PAHP to make an authorization decision.
