What type of Grievance is this?
Provider was rude and had bad bedside manner
QOS
Is it important to investigate if a claim is in involved with the compliant, and if so should we document that claim S#?
Yes, especially if its a QOC
In your resolution if you had to reach out to an
Call Center/ Advocate-Interaction
Ohh wow, you finally answered. It took you like 30 min just to answer my call
Member is expressing dissatisfaction due to long hold time.
member is requesting extended transportation
OD
Member feels they are not receiving adequate care from NP / PA, and wishes to see their PCP/provider, but cannot
QOC
True or False
Can you document the names of UHC Government Operations Customer Service advocates.
False
Member claims they never saw a provider or received a service on a specific date
Fraud, Waste and Abuse
Hi. I've been waiting 2 hours for my ride home, where is my ride?
Member expressing dissatisfaction to long wait on ride/ late pick up.
VG
Provider's office, facility, or hospital is messy, but does not pose a health or safety risk
QOS
When member is expecting DME is it important to add the date of expected deliver within the documentation?
Yes.
Medication was ordered but still not received
Optumrx/ compliant about optumrx mail order services
Can you put me on hold without the music? I really hate that hold music!!
Complaint about Hold Music
Member is inquiring why fulfillment is late
not a grievance; just an inquiry
Member was prescribe Ozempic only to find out that its not covered by plan
CD- Coverage Determination
If compliant is about the same provider/transportation vendor but different DOS is it ok to document in the same compliant intent?
Yes.
OTC products not received
OTC/ Products and supplies
I'm very upset, I was transferred several times
Complaint about Call Time/Hold/Transfers
Member needs her NovoLog covered
CD
Member called in stating she has been having her wheelchair for 8 yrs and its breaking down. She would like to get a new one.
OD- Organization Determination
Member calls in upset with provider bc he has bad bedside manners and he shoes makes a loud noise when he walks. Should all this be apart of the documentation?
No. Her opinion of the providers shoes have no impact on the member health.
Outbound Campaign/ promotional Calls
Plan/Excessive Calls from plan or plan vendor
Member called in expressing dissatisfaction alleging that they cannot access the Optum Rx website.
Complaint about OptumRx website
Member loves her Navigator
Happy- not a grievance