The HOI Complaint and Grievance Process also permits you or your Physician, to expedite HOI's review of certain types of Grievances. This process must be followed if you have a Complaint or Grievance. Under the HOI Complaint and Grievance Process, your Complaint will be handled informally as defined below in the Informal Review subsection. Your Grievance will be handled formally as instructed in the Formal Review subsection below. If we are unable to resolve the matter on an informal basis, you may submit your formal request for review in writing.
Grievance means a written expression of dissatisfaction.
You, or your provider acting on your behalf, or a state agency may submit a Grievance. A Grievance concerning an Adverse Determination is called an Adverse Determination Grievance. Internal Review Panel means a panel established by HOI to review Adverse Determination Grievances. This panel consists of Physicians who have appropriate expertise, and who were not previously involved in the initial Adverse Determination. Urgent Grievance means a request by you, or your provider, acting on your behalf, for expedited review of an Adverse Determination Grievance concurrently or prior to treatment when, as determined by HOI, the standard Grievance procedure time frame could jeopardize your life or health or your ability to regain maximum function because a health care provider has refused to or will not provide you needed medical care without a guarantee of coverage or payment.