HMO Grievance And Appeals

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All HMO's have a grievance procedure to provide adequate and reasonable procedures for the resolution of grievances initiated by enrollees. Grievances are not considered formal until a written grievance is executed and must be filed within one (1) year from the date of occurrence. If a subscriber is not happy with the outcome of the appeal through the HMO, they may then appeal to the Offices of the Insurance Commissioner (If you are an HMO subscriber through a state agency, such as PEIA or Medicaid, you must appeal to that agency, before appealing to the Offices of the Insurance Commissioner).