Anbieterhandbuch

Trauerprozess

A grievance is defined as a request by a member or member representative to have Carelon reconsider a decision solely concerning the medical necessity, appropriateness, health care setting, level of care, or effectiveness of a covered service. A provider may be involved and/or act on the member’s behalf if written authorization has been obtained from the member. This can be accomplished by filling out the Beschwerdefreigabeformular.

Eine detaillierte Beschreibung der Beschwerde-, Beschwerde- und fairen Anhörungsverfahren finden Sie in beiden Fällen Anhang H. und Anhang AA.