WHEN YOU HAVE A COMPLAINT Sample Clauses

WHEN YOU HAVE A COMPLAINT. You can call or write to us when you have a complaint about a benefit or coverage decision, Customer Service, or the quality or availability of a health care service. We recommend, but don't require, that you take advantage of this process when you have a concern about a benefit or coverage decision. There may be times when Customer Service will ask you to submit your complaint for review through the formal internal appeals process outlined below. We will review your complaint and notify you of the outcome and the reasons for our decision as soon as possible, but no later than 30 days from the date we received your complaint. If we declined to provide payment or benefits in whole or in part, and you disagree with that decision, you have the right to request that we review that adverse benefit determination through a formal, internal appeals process. This plan's appeals process will comply with any new requirements as necessary under state and federal laws and regulations. An adverse benefit determination means a decision to deny, reduce, terminate or a failure to provide or to make payment, in whole or in part for services. This includes:  A member's or applicant's eligibility to be or stay enrolled in this plan or health insurance coverage  A limitation on otherwise covered benefits  A clinical review decision  A decision that a service is experimental, investigational, not medically necessary or appropriate, or not effective. By federal law, if you enrolled through The Exchange they are responsible for all eligibility decisions, not us. If an adverse benefit determination involved member’s or applicant’s eligibility to be or stay enrolled in this plan, your appeal should be filed with The Exchange. Please contact The Exchange at 000-000-0000 (TTY/TTD 855-627- 9604) or xxx.xxxxxxxxxxxx.xxx for information on this process. If we receive an appeal from you, we will forward it to The Exchange. The Exchange is responsible for the internal Appeal process as well as the external review process.
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Related to WHEN YOU HAVE A COMPLAINT

  • Contact Us If You Have a Question If you have questions about your benefits or anything in this agreement, we are happy to help. Simply call our Customer Service Department or visit one of our Your Blue Store locations. As a BCBSRI member, you may also log in to our secure member website to find out BCBSRI news, get plan information or use many of our self-service options.

  • What Will Happen After We Receive Your Letter When we receive your letter, we must do two things:

  • When You Have More Than One Plan with BCBSRI If you are covered under more than one plan with us, you are entitled to covered benefits under both plans. If one plan has a benefit that the other(s) does not, you are entitled to coverage under the plan that has the benefit. The total payments you receive will never be more than the total allowable expense for the services you receive.

  • Happen After We Receive Your Letter When we receive your letter, we must do two things:

  • Complaints Investigation The employee who complains of harassment under the provisions of the Human Rights Code must first comply with the Employer’s harassment policy procedures before filing a grievance or human rights complaint.

  • About us The Newfoundland and Labrador Centre for Health Information (the Centre) was established by the Government of Newfoundland and Labrador to provide quality information to health professionals, the public, researchers, and health system decision-makers. Through collaboration with the health system, the Centre supports the development of data and technical standards and maintains key health databases, prepares and distributes health reports and supports and carries out applied health research and evaluations. The Centre’s mandate also includes responsibility for the provincial Electronic Health Record. The Centre is a crown agency governed by a board of directors appointed by Lieutenant- Governor-in- Council and is managed by a president & chief executive officer.

  • Xxxxx, Haldimand, Norfolk An employee shall be granted five working days bereavement leave with pay upon the death of the employee’s spouse, child, stepchild, parent, stepparent, legal guardian, grandchild or step-grandchild.

  • NO HARDSTOP/PASSIVE LICENSE MONITORING Unless an Authorized User is otherwise specifically advised to the contrary in writing at the time of order and prior to purchase, Contractor hereby warrants and represents that the Product and all Upgrades do not and will not contain any computer code that would disable the Product or Upgrades or impair in any way its operation based on the elapsing of a period of time, exceeding an authorized number of copies, advancement to a particular date or other numeral, or other similar self-destruct mechanisms (sometimes referred to as “time bombs,” “time locks,” or “drop dead” devices) or that would permit Contractor to access the Product to cause such disablement or impairment (sometimes referred to as a “trap door” device). Contractor agrees that in the event of a breach or alleged breach of this provision that Authorized User shall not have an adequate remedy at law, including monetary damages, and that Authorized User shall consequently be entitled to seek a temporary restraining order, injunction, or other form of equitable relief against the continuance of such breach, in addition to any and all remedies to which Authorized User shall be entitled.

  • Notice of Criminal Activity and Disciplinary Actions a. Xxxxxxx shall immediately report in writing to their contract manager when Xxxxxxx has knowledge or any reason to believe that they or any person with ownership or controlling interest in the organization/business, or their agent, employee, contractor or volunteer that is providing services under this Contract has: 1. Engaged in any activity that could constitute a criminal offense equal to or greater than a Class A misdemeanor or grounds for disciplinary action by a state or federal regulatory authority; or 2. Been placed on community supervision, received deferred adjudication, or been indicted for or convicted of a criminal offense relating to involvement in any financial matter, federal or state program or felony sex crime. b. Grantee shall not permit any person who engaged, or was alleged to have engaged, in any activity subject to reporting under this section to perform direct client services or have direct contact with clients, unless otherwise directed in writing by the System Agency.

  • Investigatory Interview When the employee under investigation is to be interviewed concerning the alleged conduct which could result in discharge or other discipline, the employee and his or her representative shall be notified in writing, at least forty-eight (48) hours prior to the interview. In the event of an emergency, such reasonable notice as the circumstances permit shall be given. The notice shall state that an official investigation is being conducted and shall state the subject matter of the investigatory interview. a. Prior to being interviewed pursuant to this section, the employee shall be afforded a reasonable opportunity and facilities to contact and consult privately with his or her union representative or union attorney. b. Any interview of an employee under this section shall be conducted at a reasonable time, at a suitable location and, when practicable, on the department’s premises when the employee is on duty. The union representative or union attorney may participate in the interview. c. The interview shall be limited to questions that are directly, narrowly, and specifically related to the employee’s job performance as it relates to the allegation(s) or complaints. The employee shall not be subjected to any offensive language nor be threatened with transfer, dismissal or other disciplinary action. Confidentiality of the interview shall be maintained.