果冻传媒

What is an Appeal?

If 果冻传媒 denies, limits, reduces, suspends, or stops a service, you have the right to ask us to review our decision. This is called an Appeal.

You may file an Appeal phone or by mail.

How do I file an Appeal?
You may file an Appeal by:

Phone

• Local: 713.295.2294
• Toll-free:1.888.760.2600聽 or (TTY 7-1-1)

Mail
果冻传媒, Inc.
Attention: Medical Affairs 鈥� Medical Appeals Department
4888 Loop Central Drive, Suite 600
Houston, TX 77081

Behavioral Health Appeals
果冻传媒 Texas, Inc.
Attention: Medical Affairs 鈥� Behavioral Health Appeals
P.O. Box 301411
Houston, TX 77230

If you need help completing your Appeal, Member Services can assist you by call 713.295.2294 or toll-free at 1.888.760.2600 or (TTY 7-1-1).

Appeal Forms
If you need an Appeal Form or would like assistance completing one, please contact Member Services at聽713.295.2294聽or toll-free at聽1.888.760.2600 or (TTY 7-1-1). A Member Services representative can provide an Appeal Form and answer any questions about the Appeals process.

How long do I have to file an Appeal?

You have聽60 days聽from the date on your denial notice to ask for an Appeal.

If you want your services to continue while your Appeal is reviewed, you must request that within聽10 days聽of the denial notice.

How long will the Appeal take?

We will make a decision within聽30 calendar days聽after we receive your Appeal.

If we need more information and the delay is in your best interest, we may extend the review by聽up to 14 calendar days. We will notify you if we need more time.

Expediated Appeals

If waiting for a standard Appeal could seriously harm your life or health, you may ask for an聽Expedited Appeal.

You may request an Expedited Appeal by phone or in writing.

If your request qualifies, we will:

• Make a decision within聽72 hours聽after receiving all needed information.
• Mail the decision within聽three business days聽after the decision is made.

If your request does not qualify for an Expedited Appeal, it will be reviewed as a standard Appeal.

Independent Review Organization (IRO)

If you disagree with the Appeal decision, you may have the right to request an聽Independent Review Organization (IRO)听谤别惫颈别飞.

You must request an IRO review within聽4 months聽after receiving the final Appeal decision.

For more information about the IRO process, see聽page 57 of the CHIP Member Handbook.

Need Help?

A 果冻传媒 Member Advocate can help you:

• File an Appeal.
• Check the status of your Appeal.
• Answer questions about the Appeals process.
• Complete Appeal forms.

Call Member Services at聽713.295.2294聽or toll-free at聽1.888.760.2600聽(TTY 7-1-1).

For more information about the Appeals process, see聽pages 55鈥�58 of the CHIP Member Handbook.