What is a Grievance?

whatisgrievnc

A grievance (complaint) is an oral or written expression of dissatisfaction made by a member. It can include any complaint, dispute or request for reconsideration.

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.
  • You feel that you are being encouraged to leave (disenroll from) a Molina Healthcare Health Plan.
  • Problems with the service you received.
  • Problems with how long you have to spend waiting on the phone, in the waiting room, in a pharmacy or in the exam room.
  • Disrespectful or rude behavior by providers, nurses, receptionists, pharmacists or other health care staff.
  • Problems with the cleanliness or condition of providers' offices, clinics, network pharmacies, or hospitals.
  • You have difficulty understanding our notices and other written materials.

 

If you have one of these types of problems and want to make a complaint, it is called “filing a grievance."

You may have to pay for services that are not covered. You may also have to pay for services from providers not part of our network. If the services were an emergency, you don’t have to pay. If you need help, call Member Services.