Concurrent Care Claim Extension. A request to extend or a decision to reduce a previously approved course of treatment. Treated like an urgent care claim or a pre-service claim depending on the circumstances. Treated like an urgent care claim or a pre-service claim depending on the circumstances Post-Service Claim. Any claim for a benefit that is not a pre- service claim. Within 30 calendar days Review provided by HMO personnel not involved in making the adverse benefit determination. Within 30 calendar days Review provided by HMO Appeals Committee. A Member and/or an authorized representative may attend the Level Two Appeal hearing and question the representative of HMO and/or any other witnesses, and present their case. The hearing will be informal. A Member’s Physician or other experts may testify. HMO also has the right to present witnesses.
Concurrent Care Claim Extension. A request to extend a course of treatment previously pre-authorized by HMO.
Concurrent Care Claim Extension. A request to extend or a decision to reduce a previously approved course of treatment. Treated like an urgent care claim or a pre-service claim depending on the circumstances. Post-Service Claim. Any claim for a benefit that is not a pre-service claim. Within 30 calendar days. Review provided by personnel not involved in making the adverse benefit determination.
Concurrent Care Claim Extension. A request to extend or a decision to reduce a previously approved course of treatment. Treated like an urgent care claim or a pre- service claim depending on the circumstances. Treated like an urgent care claim or a pre- service claim depending on the circumstances. Post-Service Claim or Complaint Review. Any claim for a benefit that is not a pre-service claim, or for review of a Member’s Complaint. Within 30 calendar days. If a Post-Service Claim review provided by HMO personnel not involved in making the adverse benefit determination. Within 30 calendar days. If a Post-Service Claim review provided by HMO Appeals Committee. A Member and/or an authorized representative may attend the Level Two Appeal hearing and question the representative of HMO any other witnesses, and present their case. The hearing will be informal. A Member’s Physician or other experts may testify. HMO also has the right to present witnesses. If a Member is not satisfied with the initial response to a Complaint or chooses to file a written Complaint, the Complaint will be reviewed by HMO following the time frames outlined in the chart above. If a Member chooses to file a written Complaint with HMO, the Complaint must be addressed to Aetna Health Inc., Regional Appeals Unit, 00000 Xxxxx Xxxx Xxx, Xxxxxxxxxx, XX 00000. Telephone: 000-000-0000, toll-free.
Concurrent Care Claim Extension. A request to extend or a decision to reduce a previously approved course of treatment. Post-Service Claim. Any claim for a benefit that is not a pre-service claim. Within 15 calendar days Review provided by HMO personnel not involved in making the adverse benefit determination. Treated like an urgent care claim or a pre- service claim depending on the circumstances Within 14 business days for a claim that involves Utilization Review. Otherwise, within 30 calendar days Review provided by HMO personnel not involved in making the adverse benefit determination. Within 15 calendar days Review provided by HMO Appeals Committee. Treated like an urgent care claim or a pre- service claim depending on the circumstances Within 30 calendar days Review provided by HMO Appeals Committee. A Member and/or an authorized representative may attend the Level Two Appeal hearing and question the representative of HMO and/or any other witnesses, and present their case. The hearing will be informal. A Member’s Physician or other experts may testify. HMO also has the right to present witnesses.
Concurrent Care Claim Extension. A request to extend or a decision to reduce a previously approved course of treatment. Treated like an urgent care claim or a pre-service claim depending on the circumstances. Post-Service Claim. Any claim for a benefit that is not a pre-service claim. Within 30 calendar days Review provided by personnel not involved in making the adverse benefit determination.
Concurrent Care Claim Extension. A request to extend or a decision to reduce a previously approved course of treatment. Treated like an urgent care claim or a pre-service claim depending on the circumstances Post-Service Claim. Any claim for a benefit that is not a pre-service claim. 14 calendar days from receipt of the appeal. Review provided by HMO personnel not involved in making the adverse benefit determination.
Concurrent Care Claim Extension. A request to extend a course of treatment previously pre- authorized by HMO. If an urgent care claim as soon as possible, but not later than 24 hours provided the request is received at least 24 hours prior to the expiration of the approved course of treatment. A decision will be provided not later than 15 calendar days with respect to all other care, following a request for a Concurrent Care Claim Extension.
Concurrent Care Claim Extension. A request to extend a course of treatment previously pre- authorized by HMO. If an urgent care claim, as soon as possible but not later than 24 hours. Otherwise, within 15 calendar days. Concurrent Care Claim Reduction or Termination. Decision to reduce or terminate a course of treatment previously pre-authorized by HMO. With enough advance notice to allow the Member to Appeal. Post-Service Claim. A claim for a benefit that is not a pre-service claim. Within 30 calendar days. COMPLAINTS AND APPEALS HMO has procedures for Members to use if they are dissatisfied with a decision that the HMO has made or with the operation of the HMO. The procedure the Member needs to follow will depend on the type of issue or problem the Member has. • Appeal. An Appeal is a request to the HMO to reconsider an adverse benefit determination. The Appeal procedure for an adverse benefit determination has two levels. • Complaint. A Complaint is an expression of dissatisfaction about quality of care or the operation of the HMO. The Complaint procedure may, if the Member chooses, follow the same path as an Adverse Benefit Determination.
Concurrent Care Claim Extension. A request to extend or a decision to reduce a previously approved course of treatment. Treated like an urgent care claim or a pre-service claim depending on the circumstances. Treated like an urgent care claim or a pre-service claim depending on the circumstances Post-Service Claim Any claim for a benefit that is not a pre- service claim. Both Levels Within 30 calendar days Review provided by HMO personnel not involved in making the adverse benefit determination. Review provided by HMO personnel not involved in making the adverse benefit determination or Level One Appeal decision. A Member and/or an authorized representative may attend the Level Two Appeal hearing and question the representative of HMO and/or any other witnesses, and present their case. The hearing will be informal. A Member’s Physician or other experts may testify. HMO also has the right to present witnesses.
