The procedure by which a member or healthcare provider is allowed to file a complaint with a health insurance company and seek a remedy.

The required appeal process an HMO provides for you to protest a decision regarding medical necessity or claim payment. Insurance companies also may have grievance procedures.

Definition A process instituted by a health plan or benefit provider for policyholders to file complaints.

the several stages or steps established for the resolution of grievances NOTE: A grievance procedure typically calls for initial complaints to a supervisor and leads ultimately to arbitration as a ...

  A formal and agreed process that bargaining parties are required to follow in an attempt to deal with or resolve their grievances. Typically grievance handling follows a number of sequential steps that are laid down in the procedure. The steps tend to involve progressively higher levels of management and employee representatives. Procedures gener [..]

This sets out how to complain about something in your employment terms and conditions which affects you.

the required appeal process an HMO/insurance company provides to protest a decision regarding a claim payment

Defined process in a health plan for consumers or providers to use when there is a disagreement about a plan’s services, billings, or general procedures.