Which example best represents a complaint that affects Star Ratings?

The example that best represents a complaint affecting Star Ratings is when the beneficiary enrolling in a PPO plan did not understand how the plan worked with in-network and out-of-network providers. This scenario highlights a critical aspect of member experience and satisfaction. Star Ratings are significantly influenced by member complaints, specifically regarding their understanding of plan benefits and network coverage.

When beneficiaries do not fully grasp the intricacies of their plan, such as the difference in coverage and costs between in-network and out-of-network providers, it can lead to frustration, dissatisfaction, and eventually formal complaints. Such feedback is crucial as it directly impacts the quality of care and service the health plan provides, which is central to how Star Ratings are calculated. Health plans aim to ensure that members have the information and support needed to navigate their benefits optimally, thereby enhancing member satisfaction and the overall rating of the plan.

In contrast, the other scenarios reflect more administrative completions of policies rather than issues affecting the beneficiary's understanding or satisfaction with their healthcare experience. Enrolling in the correct plan or having an in-network provider are positive indicators, but they do not relate directly to member complaints that would influence Star Ratings.