Common use of External Appeals Clause in Contracts

External Appeals. If you are unhappy with the outcome of Trinity Health PACE Alexandria ’s appeal review, you have additional appeal rights under Medicaid and Medicare. The Medicaid program conducts their next level of appeal through the State’s Fair Hearing process, and the Medicare program contracts with an “independent review entity” to provide an external review on appeals. Trinity Health PACE Alexandria will offer assistance to you in choosing which appeals process to pursue, if both are applicable, and will forward the appeal to the agency you choose. You will be contacted by the external review agency when a decision has been reached. If the ruling is in your favor, Trinity Health PACE Alexandria will continue, provide, or pay for the appealed service as quickly as your health condition requires. If the ruling is not in your favor, you may file an appeal in State Court. If you do not choose to pursue another appeal, Trinity Health PACE Alexandria will discontinue the service, and/or request repayment for cost of services provided that were being appealed, if applicable.

External Appeals. If you are unhappy with the outcome of Trinity Health PACE Alexandria Alexandria’s decision on your appeal reviewis not fully in your favor, you have additional appeal rights under Medicaid and Medicare. Medicare called external appeal rights The Medicaid program conducts their next level of appeal through the State’s Fair Hearing process, and the Medicare program contracts with an “independent review entity” to provide an external review on appeals. Trinity Health PACE Alexandria will offer assistance to you in choosing which appeals process to pursue, if both are applicable, and will forward the appeal to the agency you choose. You will be contacted by the external review agency when a decision has been reached. If the ruling is in your favor, Trinity Health PACE Alexandria will continue, provide, or pay for the appealed service as quickly as your health condition requires. If the ruling is not in your favor, you may file an appeal in State Court. If you do not choose to pursue another appeal, favor Trinity Health PACE Alexandria will discontinue the service, and/or request repayment for cost of services provided that were being appealed, if applicable.