What is a grievance?

A grievance is a formal complaint or dispute, other than an organization determination, expressing dissatisfaction with the manner in which the health plan or a delegated provider provides healthcare services that may include complaints regarding the timeliness, appropriateness, access to, and/or setting of a provided health service, procedure, or item. A grievance may also include complaints that a covered healthcare service procedure or item during a course of treatment did not meet accepted delivery standards.