What is a Complaint?
A complaint is an oral or written expression of not being satisfied. This can be any complaint. This can be a dispute. This can be a request for reconsideration. This can be a appeal made by a member.
What types of problems might lead to you filing a complaint?
- Problems with the quality of the medical care you get. This is, including quality of care when you stay at a hospital.
- If you feel that you are being encouraged to leave (Molina Healthcare Health Plan).
- Problems with the member service you get.
- Problems with finding a doctor in my area.
- Problems with how long you wait on the phone. Problems in the waiting room. Problems in a network pharmacy. Problems in the exam room.
- Problems with getting appointments when you need them. Problems having to wait a long time for an appointment.
- Rude behavior by doctors, nurses, receptionists, network pharmacists or other staff.
- If a doctor's office, clinic, network pharmacy or hospital is not clean.
- If you do not agree with our decision not to expedite your request for an expedited coverage determination. If you do not agree with our organization determination. If you think our notices and other written materials are hard to understand.
- If we do not give you an answer within the required timeframe.
If you have one of these problems and want to make a complaint, you can. It is called “filing a complaint.” In certain cases, you can ask for an “expedited complaint.” This means your complaint will be decided no later than 72 hours.