Member complaints and grievances, UnitedHealthcare West - 2022 UnitedHealthcare Administrative Guide

Member satisfaction (California)

In addition to the NCQA CAHPS® survey, we conduct an annual California HMO member assessment survey using a sample of members at the health care provider organization or medical group level. We summarize the results at the medical group level and use them to identify improvement opportunities. These results are important for the evaluation of member perspectives about access to PCP, specialty and after-hours care. In addition to access, topics include care coordination and interactions with the doctor and the office staff. 

We use the results from this survey to support the Integrated Healthcare Association’s Pay-for-Performance Program.

Member disputes may arise from time to time with UnitedHealthcare West or with our participating health care providers. UnitedHealthcare West respects the rights of its members to express dissatisfaction regarding quality of care or services and to appeal any denied claim or service.

Find instructions on how to file a complaint or grievance with us in the member’s Combined Evidence of Coverage and Disclosure Form, Evidence of Coverage, or Certificate of Coverage.

Availability of grievance forms

California Commercial HMO members may access grievance forms online. Direct members to myuhc.com > Find a Form. The form is accessible in 2 places: From the California member welcome page or, Library tab page, on the left side, and click on Grievance Form. You and your staff are required to assist the member with obtaining a form if the member asks. You may print a form from myuhc.com or by providing a number for the member to call Member Services to file the grievance orally. Grievance forms are available in English, Spanish and Chinese.