Common use of To File a Formal Grievance Clause in Contracts

To File a Formal Grievance. A Grievance is a written expression of dissatisfaction with Us or with Provider services. If the Member does not feel his Complaint was adequately resolved or he wishes to file a formal Grievance, a written request must be submitted within one hundred eighty (180) days. ▇▇▇▇▇ Vision customer service department will assist the Member if necessary. The Member should send his written Grievance to: P. O. Box 791 Latham, NY 12110 A response will be mailed to the Member within (thirty) 30 business days of receipt of the Member’s written Grievance. Multiple requests to Appeal the same Claim, service, issue, or date of service will not be considered, at any level of review. ▇▇▇▇▇ Vision offers two (2) levels of Appeal for both administrative Appeals and Medical Necessity Appeals. If a Member is an ERISA Member, the Member is required to complete the first level of Appeal prior to instituting any civil action under ERISA section 502(a). The second level of Appeal is voluntary. Any statute of limitations or other defense based on timeliness is tolled during the time any voluntary Appeal is pending. The Member’s decision whether or not to submit to this voluntary level of review will have no effect on the Member’s rights to any other Benefits under the plan. No fees or costs will be imposed on the Member. The Member should contact his Employer, Plan Administrator, Plan Sponsor, or Our Customer Service Department at ▇-▇▇▇-▇▇▇-▇▇▇▇ if the Member is unsure whether ERISA is applicable. The Member may also call ▇▇▇▇▇ Vision if they have questions or need assistance putting their Appeal in writing. Providers will be notified of Appeal results only if the Provider filed the Appeal.

To File a Formal Grievance. A Grievance is a written expression of dissatisfaction with Us or with Provider services. If the Member does not feel his Complaint was adequately resolved or he wishes to file a formal Grievance, a written request must be submitted within one hundred eighty (180) days. ▇▇▇▇▇ Vision customer service department will assist the Member if necessary. The Member should send his written Grievance to: P. O. Box 791 Latham, NY 12110 A response will be mailed to the Member within (thirty) 30 business days of receipt of the Member’s written Grievance. Multiple requests to Appeal the same Claim, service, issue, or date of service will not be considered, at any level of review. ▇▇▇▇▇ Vision offers two (2) levels of Appeal for both administrative Appeals and Medical Necessity Appeals. If a Member is an ERISA Member, the Member is required to complete the first level of Appeal prior to instituting any civil action under ERISA section 502(a). The second level of Appeal is voluntary. Any statute of limitations or other defense based on timeliness is tolled during the time any voluntary Appeal is pending. The Member’s decision whether or not to submit to this voluntary level of review will have no effect on the Member’s rights to any other Benefits under the plan. No fees or costs will be imposed on the Member. The Member should contact his Employer, Plan Administrator, Plan Sponsor, or Our Customer Service Department customer service department at ▇-▇▇▇-▇▇▇-▇▇▇▇ if the Member is unsure whether ERISA is applicable. The Member may also call ▇▇▇▇▇ Vision if they have questions or need assistance putting their Appeal in writing. Providers will be notified of Appeal results only if the Provider filed the Appeal.