contact member services. about benefits it may cross over into a request for benefits requiring you to forward for a decision to be made. See Dual Issue ( UM Request/OD) and Dual Issue (Pharmacy Request/CD) If a decision has already been made and they don't want to pay their cost share or feel it is wrong or denied incorrectly, this must also be opened as an appeal. Not Enough Providers (Proved False) The <Health Plan Name> works to give you a network of Access Use when the member feels Member Complains there are not enough there are not enough Providers providers that meets all of our needs. We member’s providers but we find there are. There are no including when there is also a are sorry that you feel that our network does not have network gaps. quality of service where they are enough providers. Thank you for telling us about this. complaining they are restricted to We sent your complaint to our Provider Relations a provider they don't like. Specialist, who works to manage our provider network. We always want to make sure our members You must give a listing of 3
contact member services. about benefits it may cross over into a request for benefits requiring you to forward for a decision to be made. See Dual Issue ( UM Request/OD) and Dual Issue (Pharmacy Request/CD) If a decision has already been made and they don't want to pay their cost share or feel it is wrong or denied incorrectly, this must also be opened as an appeal. Not Enough Providers (Proved False) The Member Complains there are not enough providers but we find there are. There are no network gaps. <Health Plan Name> works to give you a network of providers that meets all of our member’s needs. We are sorry that you feel that our network does not have enough providers. Thank you for telling us about this. We sent your complaint to our Provider Relations Specialist, who works to manage our provider network. We always want to make sure our members Access Use when the member feels there are not enough Providers including when there is also a quality of service where they are complaining they are restricted to a provider they don't like. You must give a listing of 3
ICE_AG_Grievance_Resolution_Matrix___Final(1).docx