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Consumer Guide to Health Care

Examples of Reasons to File a Grievance

1. Claims or benefits are denied because care:

   • is considered experimental

   • is considered not medically necessary

   • is for a preexisting condition

   • is not covered by your policy

   • was not preauthorized

   • was provided by a provider who is not part of your plan

   • was provided in an emergency setting but was not considered an emergency

2. Part of a claim was not paid because:

   • the charge was considered above what is "usual and customary"

   • a deductible or copayment was mistakenly applied

3. You are dissatisfied with the quality of your care

4. You are denied access to certain drugs or medical devices

5. You experience problems getting appointments, referral requests, or preauthorizations

Back to the How to Deal with Problems with Your Health Insurance Page

Last Revised: July 29, 2008