If Left Unresolved, Member Complaints About the Actions or Decisions

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