Complaint Form

A complaint is considered as the following: Any oral or written communication made directly or indirectly to Beam by any members, brokers, admins, or providers who are alleging that Beam has violated a state law or regulation, inappropriately handled any part of the insurance transaction, or any statement received from a customer that they are dissatisfied with the services provided directly by our company.
 
 

Submission info

 
First & last name Beam employee who handled complaint
 
 
Date complaint was received
 
mm/dd/yyyy
 
Date submitted to this form
 
mm/dd/yyyy
 
 

Complaint info

 
Kustomer or Zendesk #
 
 
 
Overview of complaint details and any questions/follow ups that need to be addressed.
 
 
First & last name or Provider name
 
 
 
 
Please use 2 letter code (i.e. "OH" for "Ohio")
 
 
Is this related to a claim that needs appealed?
 
 
 
If yes, please submit the HIPAA Breach form here: https://app.smartsheet.com/b/form/aa1c1d90772c4ee8bce820e6575af6cf
 
 

Resolution

 
Include: 1) What is the main problem of the complaint? 2) Is this a follow up on previous issues/Zendesk tickets? If so, please include those ticket numbers. 3) Any follow up requests from complaintant. 4) Additional important info
 
 
What is the status of the complaint?
 
Which department needs to be notified to help resolve/add additional information this complaint?
 
Please include: 1) Dates of follow up correspondence with complainant 2) Attach files of closed Zendesk tickets or email correspondence 3) Clarifying details about complaint problem and how it was resolved
 
 
mm/dd/yyyy
 
 
Up to 10 files can be uploaded Each file size can be a max of 30 MB
Drop your files here