Differentiate between grievances and appeals in MA/Part D and typical timelines.

• A. Grievances are complaints about access or service; appeals challenge plan decision on coverage or payments; timelines typically range from days to 30–60 days depending on urgency and process
• B. Grievances are about provider networks; appeals are about payments
• C. Grievances are for payments; appeals about service
• D. Appeals must be resolved within 5 days

Answer: (A)

In MA/Part D, grievances are complaints about access to care or the way services are delivered, while appeals are requests to reverse a plan’s decision about coverage or payments for a service or a drug. Grievances are meant to be resolved quickly—often within days and up to about a month—with faster handling if the issue is urgent. Appeals involve a more formal review of a plan’s denial or limitation on coverage or payment, so their timelines are longer and depend on urgency and the specific step in the process; a typical range is up to 30–60 days for standard internal or external reviews, with expedited options available for urgent situations. The statement captures both what each process addresses and the practical timeframes you’re likely to encounter.