If a patient disagrees with an insurer's denial and requests a formal review, which right are they exercising?

• A. Right to Information
• B. Right to Confidentiality
• C. Right to Grievance and Appeals
• D. Right to Access Emergency Services

Answer: (C)

When a patient wants to challenge an insurer’s denial, they are exercising the right to Grievance and Appeals. A grievance is a formal complaint about the plan’s actions, and an appeal is the process to have the denial reconsidered or reversed. This typically involves submitting a written request within a set timeframe, providing relevant medical records and supporting documentation, and going through the insurer’s internal review process, with the option of escalating to external review if needed.

The other rights do not fit this scenario: the Right to Information is about obtaining details of coverage and benefits, the Right to Confidentiality protects the privacy of medical information, and the Right to Access Emergency Services ensures timely emergency care regardless of payment issues.