제공자 매뉴얼

고충처리 절차

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 불만 제기 양식.

불만, 고충 및 공정한 청문회 절차에 대한 자세한 설명은 부록 H 과 부록 AA.