QOC or QOS
Member complained that they could not contact the providers office regarding a missing script for a blood pressure medication.
What is Quality of Care.
The member complains that the plan sends too much paper.
What is Complaint About Fulfillment Polices?
Transportation was late or did not arrive, but member was able to arrange other transportation.
What is Quality of Service ?
Broker enrolled the member with the wrong start date-member was advised start date would be 12/01/2025 instead member recieved a notice stating her start date would be 01/01/2026
What is Sales Agent/Broker Fraud, Misrepresentation or Behavior?
The vehicle was dirty / unclean and poses a health / safety risk for example broken glass -open needles etc.
What is Quality of care?
Member complained that her plan requires a referral from her PCP in order to see a specialist.
What is the CD / OD / Appeals Process?
Delay or defect in receiving items ordered through the over-the-counter (OTC) benefit only when there is an indication the member's care has been impacted-like member unable to get incontinence supple and resulted in a rash or pressure ulcer.
What is Quality of Care?
Member called and complained that their card won't work at the store.
What is OTC, Healthy Foods, and Utilities?
Delay in receiving, or not receiving, OTC items when the member’s care is not affected
What is a Quality of Service?
Medication order or refill was requested, but not received or not received timely.
What is Pharmacy?