Practice Quiz

Managed Care Nursing

Category - Patient Issues

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As defined by Medicare, which definition(s) best explain this difference between a complaint or grievance and an appeal? Choose all that apply.
  1. A complaint or grievance is a concern about the quality or safety of care received
  2. An appeal can be related to the way a provider treated you during an exam or a drug not covered or denied by insurance
  3. An appeal may be related to a lack of coverage for a specific drug
Explanation
Answers: A and C-A complaint or grievance is a concern related to quality or the insurance company can relate safety of care and an appeal to provider or staff treatment or coverage or drug denial. An appeal is usually related to a lack of coverage for a specific drug, service, or item.
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