An appeal is when you ask for a formal hearing when you do not agree with a decision made by your health plan. You have the right to appeal when your health plan:
Denies or limits a service approval request
Does not approve a service in an amount length of time, or scope that you requested
Denies payment for a service
Suspends, reduces, discontinues, or terminates services
Doesn't act upon your grievance or appeal within required timeframes
Denies your request to disagree with a bill
Requesting an appeal with your health plan:
Contact a member representative from your health plan by phone or mail
The member handbook from your health plan tells you how to file an appeal
You have sixty (60) days from the date on your notice of adverse benefit determination to request an appeal with your health plan
More Information is available in the member handbooks for your plan at the following links: