US Medical Term · insurance
Grievance
Queja Formal
In 9 languages
| Language | Term |
|---|---|
| English | Grievance |
| Spanish (Español) | Queja Formal |
| Chinese (中文) | 投诉 |
| Korean (한국어) | 불만 제기 |
| Vietnamese (Tiếng Việt) | Khiếu nại |
| Filipino (Tagalog) | Reklamo |
| Portuguese (Português) | Reclamação formal |
| Thai (ภาษาไทย) | การร้องเรียน |
| Japanese (日本語) | 苦情申し立て |
What it means
A grievance is a formal complaint you file with your health insurance plan about a non-coverage issue—such as poor customer service, difficulty scheduling appointments, long wait times, or problems getting prescription refills. Grievances differ from appeals, which challenge coverage denials. Medicare Advantage and Part D plans must acknowledge urgent grievances within 24 hours and resolve standard ones within 30 days. Most marketplace and employer plans follow similar timelines. If the plan's response does not resolve your concern, you can escalate to your state insurance commissioner or to the federal Centers for Medicare and Medicaid Services. Keep written records of all grievances and responses.
How to say it
Sentences a patient might use with a doctor, nurse, pharmacist, or insurer:
filing a grievance with your plan
presentar una queja ante su plan
patient complaint to the insurer
queja del paciente al asegurador
formal plan complaint
queja formal ante el plan
Where you'll see it
Related terms
Sources
Last reviewed: September 2026