If Left Unresolved, Member Complaints About the Actions or Decisions

question 85

Multiple Choice

If left unresolved, member complaints about the actions or decisions made by a health plan or its providers can lead to formal appeals. One procedure health plans can use to address formal appeals is to submit the original decision and any supporting info

• A) A Level One appeal, and the member has the right to a further appeal
• B) A Level Two appeal, and the reviewer's decision is final and binding
• C) An independent external appeal, and the member has the right to a further appeal
• D) Arbitration, and the reviewer's decision is final and binding

---

Definitions:

Industrialized Countries

Nations with significant levels of industrialization, characterized by strong economies, technological advancement, and higher standards of living.

Escalating Costs

The increasing financial expenditures associated with a product, service, or activity, often referring to healthcare expenses.

Technological Advances

Progress in technology that enhances capabilities, efficiency, or introduces new methods and tools.

Specialists

Medical doctors trained to diagnose and treat conditions in specific areas of medicine, offering expertise in fields such as cardiology, neurology, or surgery.