An expedited appeals process should be made available for situations in which the normal time frame could jeopardize a patient's life or health. Appeals should be resolved as rapidly as warranted by the patient's situation. To promote implementation of this policy as expeditiously as possible, AAHP member plans are being encouraged to review their internal policies and practices to ensure adherence. State Grievance Procedure Requirements Internal Grievance Procedures Grievance and appeals procedures are required of health plans by the states, and by the federal government for federally qualified HMOs and other health plans contracting with Medicare as well as contractors for federal employees' health benefits. Using my state as an example, Florida requires that each health plan have a written grievance procedure available to its subscribers for the purpose of addressing complaints and grievances, an expedited grievance procedure, and external review by the state through the Statewide Subscriber and Provider Assistance Panel which will be described more fully below.
Every health plan is required by Florida law to have a grievance procedure.
Plans, as part of their procedure, must inform subscribers that they have one year from the date of the occurrence to initiate the grievance and that the member can appeal to the Statewide Subscriber and Provider Assistance Panel after the final disposition of the grievance through the plan's grievance process. Plans must respond to an initial complaint within a reasonable time. The organization must also inform the member that the member can submit a written grievance at any time. The plan in addition must inform the member that the plan will assist the member in preparing the written grievance. An explanation of how to pursue redress of a grievance.