In health insurance, what is a grievance?

In health insurance, a grievance is defined as a formal complaint regarding a health plan or the care received by a patient. This process allows individuals to express dissatisfaction with various aspects of their care, such as the quality of treatment, issues with the health plan's policies, or service-related concerns. Filing a grievance is an essential part of ensuring that issues are not only acknowledged but also addressed by the insurance provider, thus contributing to overall quality improvement in healthcare services.

The other options relate to different aspects of the healthcare and insurance processes but do not capture the essence of a grievance. For instance, a request for coverage of a new procedure pertains to the approval of specific treatments or interventions but does not involve patient dissatisfaction. A measure of satisfaction with healthcare services focuses on feedback and evaluation rather than complaint processes. Lastly, a routine audit of insurance claims is an administrative function designed to ensure accuracy and compliance, rather than addressing patient complaints or grievances.