HMO Grievance And Appeals

[ printer frinedly version ]

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 files 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 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 Insurance Commissioner).