Ensuring You Receive the Service You Deserve

By Devon Lor, MSN, RN, quality health integration clinical supervisor at Network Health

At Network Health, we want to ensure you receive the service you need and deserve. If you have concerns, we want to make sure you understand all your options. If you do not agree with Network Health’s decisions about your care or what’s covered, you have the right to file an appeal or grievance. We have a team of appeals and grievance specialists who will personally ensure your concern receives a complete and thorough review.

When do I file a grievance?

You have the right to file a grievance if you do not agree with Network Health’s decisions about your health care. Your written grievance should include your full name, member ID and detailed information about the decision you would like reviewed. You may also include any comments, documents, records or other information you would like Network Health to consider in its review.

Examples of situations appropriate for a grievance include the following.

• Network Health will not approve care you believe should be covered. • Network Health is ending coverage on care you still need. • Network Health has denied payment for services or items you have received, and you think they should be covered.

Who may file a grievance?

You or someone you name to act for you (called your representative) may file a grievance. To name your representative, visit networkhealth.com and go to the For Our Members and Employers drop-down menu and select Employer Members (if you get coverage through your employer) or Individual and Family Members (if you buy insurance on your own), and then select Member Resources. Scroll down to the Forms section and click on the Authorized Representative Form link. Complete the form and send it to the address listed on the form.