Common use of RECONSIDERATION OF DENIED REQUEST FOR PAYMENT Clause in Contracts

RECONSIDERATION OF DENIED REQUEST FOR PAYMENT. If a request for payment is denied, the MEMBER or the MEMBER's authorized representative may appeal the decision by filing a written request with MediCard Head Office within thirty (30) days after receiving a negative decision. The request must set forth why the MEMBER believes that the decision was in error. The MEMBER may examine pertinent documents not subject to "privileged communication" (as discussed in Rule 130, Section 24 of the Rules of Court) or disclosure and may submit additional written statements for consideration of the appeal. Upon completion of the procedure, the MEMBER will receive a written notice stating the final MediCard decision and the reason for such decision.