Manwal ng Tagabigay

PROSESO NG KAHILINGAN

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 Form ng Paglabas ng Reklamo.

Para sa isang detalyadong paglalarawan ng reklamo, karaingan, at mga proseso ng patas na pagdinig, mangyaring sumangguni sa pareho Apendiks H at Apendiks AA.