A grievance is any written complaint, dispute, request for review, or appeal made by a member.
What types of problems might lead to you filing a grievance?
- Problems with the quality of the medical care you receive, including quality of care during a hospital stay.
- If you feel that you are being encouraged to leave (dis-enroll from) Molina Healthcare Health Plan.
- Problems with the member service you received.
- Problems with how long you have to spend waiting on the phone, in the waiting room, in a network pharmacy or in the exam room.
- Problems with getting appointments when you need them or having to wait a long time for an appointment.
- Disrespectful or rude behavior by doctors, nurses, receptionists, network pharmacists or other staff.
- Cleanliness or condition of doctor’s offices, clinics, network pharmacies or hospitals.
- If you disagree with our decision not to expedite your request for an expedited coverage determination, organization determination, redetermination or reconsideration.
- You believe our notices and other written materials are difficult to understand.
- Failure to give you a decision within the required time frame.
- A denied prior authorization request.
If you have one of these types of problems and want to make a formal complaint in writing, it is called “filing a grievance”. In certain cases, you can ask for an “expedited grievance”, meaning your grievance will be decided in no more than two business days.