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What is a Complaint?

Complaint is an expression of dissatisfaction about any matter other than an Adverse Benefit Determination that is resolved at the point of contact rather than through filing a formal Grievance.

For example, you can make a Complaint for incidents related to, but not limited to:

  • Problems getting an appointment, or having to wait a long time for an appointment; or
  • Disrespectful or rude behavior by doctors, nurses or other health plan clinic or hospital employees.