How to Complete a Grievance

Category: File a Grievance

When to Use the SCAN Grievance Report Form

You may use this form when you have a complaint such as: 

  • The quality of services that you receive
  • Office waiting times
  • Physician behavior
  • Adequacy of facilities
  • Involuntary disenrollment issues
  • Any other areas of dissatisfaction that do not include coverage decisions
When Not to Use the SCAN Grievance Report Form

Do not use this form if your complaint is about a decision regarding the denial of services or payment. Instead, you will need to file an appeal. Please refer to your Evidence of Coverage (EOC) to find out how to file an appeal.
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