Common use of Urgent Grievance Procedure Clause in Contracts

Urgent Grievance Procedure. If You are not satisfied with a decision We made either before or after You have filed a Grievance and Your situation meets the requirements of an Urgent Grievance, You have the right to use this Urgent Care procedure. Once identified as such, an Urgent Grievance will be subject to only one review before becoming eligible for the External Appeal process described in Section 8.6. Your Urgent Grievance may be expressed to Us orally or in writing and should set forth all issues, comments, or other documented evidence that support it. We will treat Your Urgent Grievance pursuant to the procedure described in Section 8.2 and Section 8.4, except that We will shorten the time limits as follows. We will acknowledge Your Urgent Grievance within 24 hours (and include any request for additional information, if appropriate). We will decide Your Urgent Grievance as soon as possible, but no later than 72 hours after the receipt of the initial request for the Urgent Grievance. You will receive written or electronic notification of Our decision. We may notify You of Our decision orally, provided that a written or electronic notification is furnished to You no later than 3 days after the oral notification. If You do not provide sufficient information for Us to determine whether or to what extent the benefits You seek are Covered or payable under the Contract, We will notify You within 24 hours of the specific information that You must submit for Us to answer Your Claim. If You are notified that You need to provide additional information, You will have at least 48 hours in which to provide the additional information. We shall notify You of Our decision no later than 48 hours after We receive the requested information. If You do not provide the requested information, We shall notify You of Our decision no later than 48 hours after the end of the time that You were given to provide the information.