The Quality Improvement Organization does a Sample Clauses

The Quality Improvement Organization does a second review of your situation • Reviewers at the Quality Improvement Organization will take another careful look at all of the information related to your appeal. Step 3: Within 14 calendar days, the Quality Improvement Organization reviewers will decide on your appeal and tell you their decision. If the review organization says yes: • Our plan must reimburse you for our share of the costs of hospital care you have received since noon on the day after the date your first appeal was turned down by the Quality Improvement Organization. Our plan must continue providing coverage for your hospital care for as long as it is medically necessary. • You must continue to pay your share of the costs and coverage limitations may apply. If the review organization says no: • It means they agree with the decision they made to your Level 1 Appeal and will not change it. This is called “upholding the decision.” It is also called “turning down your appeal.” • The notice you get will tell you in writing what you can do if you wish to continue with the review process. It will give you the details about how to go on to the next level of appeal, which is handled by a judge.