UPMC Health Plan
Members
Miembros de
HealthChoices
HealthChoices
Members

Complaints and Grievances

Complaints and Grievances

Below you will find the Commonwealth of Pennsylvania’s definition for both a complaint and a grievance as they pertain to Medicaid behavioral health services. Please choose the topic that best applies to your current needs. Once you select an option, you will be provided additional information on the chosen topic.

  • A complaint is a dispute or objection filed with the Behavioral Health Managed Care Organization (BH-MCO) regarding a participating health care provider or the coverage, operations, or management policies of a BH-MCO.

  • A grievance is a request to have a BH-MCO or utilization review entity reconsider a decision solely concerning the medical necessity and appropriateness of a health care service.