Written complaint by a dissatisfied patient submitted to a grievance committee of an insurance plan or program. It may be about availability, delivery, or quality of medical services, utilization review decisions, insurance claims payment, or the contract relationship between a plan member and an insurer. Also see complaint .

Impartial panel of physicians who handle complaints by dissatisfied patients or their representatives against doctors.

Process or system in which a dissatisfied patient or participating provider of a managed care plan can express complaints to get a situation resolved. Such procedures include a due process provision and subject these procedures to a specific and standard adjudication method.
****
A procedure which allows an insurer or a provider of benefits to express complaints and seek remedies.

Information from a discontented patient or dissatisfied provider transmitted to a managed care plan’s grievance committee to seek remedies for resolution of the problem(s).