What does the term “grievance” mean in health insurance?

The term "grievance" in health insurance refers to a formal complaint made by a member against a healthcare provider or plan. This implies that when a policyholder is dissatisfied with the services received, treatment decisions, or other aspects of their healthcare experience, they can file a grievance to seek resolution. This process is important as it provides a structured way for members to express their concerns and ensures that the health insurance plan or provider has the opportunity to address and resolve any issues that may arise during care. By having a grievance process in place, health insurance companies can improve patient satisfaction and quality of care based on feedback from their members.