Common use of Internal Appeal Process Clause in Contracts

Internal Appeal Process. An appeal is a request to review a Notice of Adverse Benefit Determination (NABD). You can request this review by phone or in writing. You must follow a request by phone in writing unless it is an expedited appeal. An adverse decision can be when Ambetter from Sunshine Health:  Denies the care requested  Decreases the amount of care  Ends care that has previously been approved  Denies payment for care and you may have to pay for it