2024 Evidence of Coverage for UnitedHealthcare® Group Medicare Advantage PEBB Balance (PPO) Chapter 9: What to do if you have a problem or complaint (coverage decisions, appeals, complaints) 232 - If you decide to accept this decision that turns down your appeal, the appeals process is over. - If you do not want to accept the decision, you may be able to continue to the next level of the review process. If the Council says no to your appeal or denies your request to review the appeal, the notice will tell you whether the rules allow you to go on to a Level 5 appeal. It will also tell you who to contact and what to do next if you choose to continue with your appeal. Level 5 appeal: A judge at the Federal District Court will review your appeal. · A judge will review all of the information and decide yes or no to your request. This is a final answer. There are no more appeal levels after the Federal District Court. Making complaints Section 10 How to make a complaint about quality of care, waiting times, customer service, or other concerns Section 10.1 What kinds of problems are handled by the complaint process? The complaint process is only used for certain types of problems. This includes problems related to quality of care, waiting times, and the customer service. Here are examples of the kinds of problems handled by the complaint process. Complaint Example Quality of your · Are you unhappy with the quality of the care you have received medical care (including care in the hospital)? Respecting your · Did someone not respect your right to privacy or share confidential privacy information? Disrespect, poor · Has someone been rude or disrespectful to you? customer service, · Are you unhappy with our Customer Service? or other negative behaviors · Do you feel you are being encouraged to leave the plan? Waiting times · Are you having trouble getting an appointment, or waiting too long to get it? · Have you been kept waiting too long by doctors, pharmacists, or other health professionals? Or by Customer Service or other staff at our plan?