Your Right to Appeal. A Determination that A Service is Experimental or Investigational. If We have denied coverage on the basis that the service is an experimental or investigational treatment (including clinical trials and treatments for rare diseases), You must satisfy the two (2) requirements for an external appeal in paragraph “A” above and Your attending Physician must certify that Your condition or disease is one for which:
Your Right to Appeal a Determination that a Service is Out-of-Network. If We have denied coverage of an out-of-network treatment because it is not materially different than the health service available in-network, You may appeal to an External Appeal Agent if You meet the two (2) requirements for an external appeal in paragraph “A” above, and You have requested Preauthorization for the out-of-network treatment. In addition, Your attending Physician must certify that the out-of-network service is materially different from the alternate recommended in-network health service, and based on two (2) documents from available medical and scientific evidence, is likely to be more clinically beneficial than the alternate in- network treatment and that the adverse risk of the requested health service would likely not be substantially increased over the alternate in-network health service. For purposes of this section, Your attending Physician must be a licensed, board certified or board eligible Physician qualified to practice in the specialty area appropriate to treat You for the health service.
Your Right to Appeal an Out-of-Network Referral Denial to a Non-Participating Provider. If We have denied coverage of a request for a Referral to a Non-Participating Provider because We determine We have a Participating Provider with the appropriate training and experience to meet Your particular health care needs who is able to provide the requested health care service, You may appeal to an External Appeal Agent if You meet the two (2) requirements for an external appeal in paragraph “A” above. In addition, Your attending Physician must: 1) certify that the Participating Provider recommended by Us does not have the appropriate training and experience to meet Your particular health care needs; and 2) recommend a Non-Participating Provider with the appropriate training and experience to meet Your particular health care needs who is able to provide the requested health care service. For purposes of this section, Your attending Physician must be a licensed, board certified or board eligible Physician qualified to practice in the specialty area appropriate to treat You for the health service.
Your Right to Appeal a Determination that a Service is Not Medically Necessary. If We have denied coverage on the basis that the service is not Medically Necessary, You may appeal to an External Appeal Agent if You meet the requirements for an external appeal in paragraph “A” above.
Your Right to Appeal. The plan administrator is required to let you know, in writing, if he or she denies your application for benefits payments. The plan administrator must give you specific reasons for the denial. You have the right to a full review of the denial by all the trustees of the plan. If you are still unhappy with the decision, you can file a lawsuit in federal district court.
Your Right to Appeal a determination that a service is not medically necessary If the Plan has denied coverage on the basis that the service is not medically necessary, you may appeal to an External Appeal Agent if you satisfy the following two (2) criteria: • The service, procedure or treatment must otherwise be a Covered Service under the Subscriber Contract; and • You must have received a final adverse determination through the Plan’s internal appeal process and the Plan must have upheld the denial or you and the Plan must agree in writing to waive any internal appeal.
Your Right to Appeal. You have a right to appeal this Order to the Pollution Control Hearing Board (PCHB) within 30 days of the date of receipt of this Order. The appeal process is governed by Chapter 43.21B RCW and Chapter 371-08 WAC. “Date of receipt” is defined in RCW 43.21B.001(2). To appeal you must do both of the following within 30 days of the date of receipt of this Order: • File your appeal and a copy of this Order with the PCHB (see addresses below). Filing means actual receipt by the PCHB during regular business hours. • Serve a copy of your appeal and this Order on Ecology in paper form - by mail or in person. (See addresses below.) E-mail is not accepted. You must also comply with other applicable requirements in Chapter 43.21B RCW and Chapter 371-08 WAC. ADDRESS AND LOCATION INFORMATION Street Addresses Mailing Addresses Department of Ecology Department of Ecology
Your Right to Appeal. If you think the increase or decrease in the services provided or the cost of those services is unreasonable, you can apply to the County Court who will determine whether cost of those services is unreasonable. 3
Your Right to Appeal. You have the right to challenge a decision if you disagree. You have the right to ask what the process is for challenging a decision you disagree with. You have the right to have that information provided to you in writing. Most appeal processes have timelines related to how much time you have to challenge a decision.
Your Right to Appeal. You have the right to appeal against the School's decision to refuse your Request. Such an appeal must be exercised in writing within 14 days after the day the School's decision is given, giving full details of why you wish to appeal. Your notice of appeal must be dated and sent to [the Bursary].
