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) 233 Complaint Example - Examples include waiting too long on the phone, in the waiting or exam room, or getting a prescription. Cleanliness · Are you unhappy with the cleanliness or condition of a clinic, hospital, or doctor’s office? Information you · Did we fail to give you a required notice? get from us · Is our written information hard to understand? Timeliness (These If you have asked us for a coverage decision or made an appeal, and you types of think that we are not responding quickly enough, you can also make a complaints are all complaint about our slowness. Here are examples: related to the · You asked us for a “fast coverage decision” or a “fast appeal,” and we timeliness of our have said no; you can make a complaint. actions related to coverage · You believe we are not meeting the deadlines for coverage decisions decisions and or appeals; you can make a complaint. appeals) · You believe we are not meeting deadlines for covering or reimbursing you for certain medical items or services or drugs that were approved; you can make a complaint. · You believe we failed to meet required deadlines for forwarding your case to the independent review organization; you can make a complaint. Section 10.2 How to make a complaint Legal Terms A “complaint” is also called a “grievance.” “Making a complaint” is also called “filing a grievance.” “Using the process for complaints” is also called “using the process for filing a grievance.” A “fast complaint” is also called an “expedited grievance.” Section 10.3 Step-by-step: Making a complaint Step 1: Contact us promptly – either by phone or in writing.