![]() Call Member Services at 1-86 (TTY: 711).You have the right to present evidence and facts in person, in writing or by phone. Your appeal will be reviewed by a medical director or appropriately licensed professional who was not involved in the prior decision, does not report to the prior decision-maker, and will make the final decision for your appeal request. We will also send you a letter within two calendar days that includes the reason for the extension and your right to file a grievance if you disagree with our decision. If an extension is made to your appeal, we will contact you and your provider promptly by phone to let you know of our decision. You will be notified in writing of the reason for the additional time to resolve the issue. We will then give you a written decision within 30 calendar days of the date of the appeal request.Ībsolute Total Care may extend the timeframe to resolve a standard or an expedited appeal up to 14 calendar days if you or your authorized representative request an extension, or Absolute Total Care can demonstrate that there is a need for additional information that is in the your best interest. Absolute Total Care will let you know that your request will be processed as a standard appeal and your right to file a grievance if you disagree with the decision. We will also send you a written notice within two calendar days of receiving your expedited appeal request. If your request for an expedited appeal is denied we will contact you and your provider promptly by phone. An expedited appeal does not require written confirmation. We will also make efforts to contact you and your provider by phone of our decision.Ĭontact our Grievance and Appeals Coordinator at 1-86 (TTY: 711) if you think you need an expedited appeal. We will give you a written decision within 72 hours from the date of receipt of your request. Expedited Appeal –You can ask for an expedited (or fast) appeal if you or your doctor believe your health could be seriously harmed by waiting up to 30 calendar days for a decision.Standard Appeal – We will give you a written decision within 30 calendar days from the date of receipt of your request.The member can give permission for a person or a provider to act on their behalf in writing or by completing the Appointment of Authorized Representative Form found on the Member Handbooks and Forms page.An authorized representative is a person or a provider a member gives the right to act on their behalf.An Absolute Total Care member or a member’s authorized representative.This includes providing assistance with accessing interpreter services and hearing impaired services, if needed, at no cost to you. If you need assistance with your appeal please call Absolute Total Care at 1-86 (TTY: 711) and we will assist you in filing your appeal. ![]() You may also find the form on our Member Handbooks and Forms page.Īn appeal may be filed within 60 calendar days from the date on the Adverse Benefit Determination Notice. The Adverse Benefit Determination Notice will explain the appeals process and includes a copy of the Appeal Form. If you do not agree with the adverse benefit determination, you may request an appeal. You will know that Absolute Total Care made an adverse benefit determination because we will send you an Adverse Benefit Determination Notice. Denies a request to dispute a financial liability, including cost-sharing, copayments, premiums, deductibles, and coinsurance.Denies a member, who is a resident of a rural area where there is only one MCO, request to exercise his or her right to obtain services outside the Absolute Total Care network, or.Fails to act within the timeframes provided,.Fails to provide services in a timely manner, as defined by the State,. ![]()
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