What is a Grievance

grievance

A grievance is an oral or written expression of dissatisfaction, including any complaint, dispute, request for reconsideration, 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) your 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 timeframe.
  • Failure to forward your case to the independent review entity if we do not give you a decision within the required timeframe.

If you have one of these types of problems and want to make a complaint, it is called “filing a grievance”. In certain cases, you can ask for an “expedited grievance,” meaning your grievance will be decided no later than 72 hours.