grievance

  • "Grievance" means a written complaint submitted by or on behalf of an enrollee regarding the:

    (a) Availability, delivery or quality of health care services, including a complaint regarding an adverse determination made pursuant to utilization review;

    (b) Claims payment, handling or reimbursement for health care services; or

    (c) Matters pertaining to the contractual relationship between an enrollee and an insurer.

    Oregon Legislature 1