Complaints, Utilization Review, Grievance Procedures & Appeals
Use this area to find information about filing complaints, grievances and appeals through your health plan, MCHCP and the Department of Insurance, Financial Institutions and Professional Registration.
What Does the Health Plan's Grievance Review Process Include?
- An initial right to an administrative/medical review.
- A right to a second review with different individuals of a grievance panel, including representation from at least one physician from an appropriate specialty area of medicine.
- An expedited procedure for emergency cases.
The Appeals Process
- Service Complaints
- Utilization Review
- Grievance Procedures for Claims and Services
- Appeals to the MCHCP Board of Trustees
- Administrative Appeals
- Judicial Reviews
- Other Insurance Rights
- Sample Appeal Letter
What Do I Need to Include When Filing an Appeal?
When filing an appeal, be sure to include: (see sample appeal letter)
- Subscriber name
- Address
- Subscriber MCHCPid or SSN
- Member name
- “Specific” circumstances for the appeal