Coverage Denial definition

Coverage Denial means the Plan’s determination that a service, treatment, drug or device is specifically limited or excluded under the covered person’s plan. The Plan Manager is responsible for the Internal Appeal Process for Coverage Denials in accordance with KRS 304.17A-600 through 633.
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Coverage Denial means services, treatments, drugs or devices that are specifically limited or excluded under the covered person’s plan. Express Scripts is responsible for the Internal Appeal Process for Coverage Denials in accordance with KRS 304.17A.600-633.
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Coverage Denial means services, treatments, drugs or devices that are specifically limited or excluded under the covered person’s plan.
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Examples of Coverage Denial in a sentence

  • The Plan Manager shall render a decision not later than twenty-four (24) hours after receipt of the request for an expedited appeal of an Adverse Determination or Coverage Denial, unless the covered person fails to provide sufficient information to determine whether, or to what extent, benefits are covered or payable under the Plan.

  • How to file an Internal Appeal for Adverse Determination or Coverage Denial Initial Complaint – before filing an Internal Appeal, a covered person should always contact the Plan Manager’s Customer Service Department first at 866-601-6934.

  • HOW TO FILE an Internal Appeal for Adverse Determination or Coverage Denial Initial Complaint – a member should always contact the Third Party Administrator’s Customer Service Department first at 877-KYSPIRIT.

  • HOW TO FILE an External Appeal for Adverse Determination or Coverage Denial Before members can request an external appeal, they must exhaust their rights to an internal appeal.

  • How to File an Internal Appeal – Adverse Determination or Coverage Denial To appeal a denial of a hospital, physician or other provider’s services, the member, authorized person or provider should file an appeal to: Humana Grievance and AppealsP.O. Box 14546Lexington, Kentucky 40512-4546 Initial Complaint – a member should always contact the Plan Manager’s Customer Service Department first (the number is located on the back of the ID card).

  • Coverage Denial – The Third Party Administrator will handle the Internal Appeal Process for Coverage Denials in accordance with KRS 304.17A.600-633.

  • The Plan Administrator is responsible for handling Administrative Appeals.How to file an Internal Appeal for Adverse Determination or Coverage Denial Initial Complaint – before filing an Internal Appeal, a covered person should always contact the Plan Manager’s Customer Service Department first at 866-601-6934.

  • Coverage Denial – The Plan Manager will handle the Internal Appeal Process for Coverage Denials in accordance with KRS 304.17A-600 through 633.

  • The obligation for the Remus Capital to comply with this Section 7.2.3(a) shall automatically terminate without any further action at such time as Remus Capital no longer meets the Remus Minimum Ownership Threshold.

  • You may be entitled to an independent external review of a final Coverage Denial Determination involving care which has been determined not to meet the Plans’ requirements for medical necessity, appropriateness, health care setting, level of care, effectiveness of care or where the requested services have been found to be experimental treatment.


More Definitions of Coverage Denial

Coverage Denial means a determination that a service, treatment, drug or device is specifically limited or excluded under the Covered Person’s health benefit plan.
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Coverage Denial means a determination that a service, treatment, drug or device is specifically limited or excluded under the Plan.
Sample 1
Coverage Denial means a determination that a service, treatment, drug or device is specifically limited or
Sample 1

Related to Coverage Denial

  • Coverage Term All insurance required herein shall be maintained in full force and effect until Work required to be performed under the terms of the Contract are satisfactorily completed and formally accepted; failure to do so may constitute a material breach of this Contract, at the sole discretion of the TOWN. In the event any insurance policy(ies) required by this contract is(are) written on a “claims made” basis, coverage shall extend for two(2) years past completion and acceptance of the CONTRACTOR’s work or services, as evidenced by annual Certificates of Insurance.

  • Coverage means the types of persons to be eligible as the beneficiaries of the Scheme to health services provided under the Scheme, subject to the terms, conditions and limitations.

  • Coverage Area means the area described in the Website for which Nearmap has available Products, which may cover part or all of that area and which may cover part (but not all) of the area covered by the Survey.

  • insurance period means a contribution period or an equivalent period;

  • Continuation Coverage means coverage under a COBRA continuation provision or a similar state program. Coverage provided by a plan that is subject to a COBRA continuation provision or similar state program, but that does not satisfy all the requirements of that provision or program, will be deemed to be continuation coverage if it allows an individual to elect to continue coverage for a period of at least 18 months. Continuation coverage does not include coverage under a conversion policy required to be offered to an individual upon exhaustion of continuation coverage, nor does it include continuation coverage under the Federal Employees Health Benefits Program.

  • Coverage Test means each of the Class A/B Par Value Test, the Class A/B Interest Coverage Test, the Class C Par Value Test, the Class C Interest Coverage Test, the Class D Par Value Test, the Class D Interest Coverage Test, the Class E Par Value Test and the Class E Interest Coverage Test.

  • Coverage territory means the United States of America (including its territories and possessions), Puerto Rico and Canada.

  • Coverage Tests means each of the Overcollateralization Ratio Test and the Interest Coverage Ratio Test.

  • Insurance Coverage Contractor shall, at Contractor’s sole expense, procure, maintain and keep in force for the duration of this Contract the following insurance conforming to the minimum requirements specified below. Unless specified herein or otherwise agreed to by the City, the required insurance shall be in effect prior to the commencement of work by Contractor and shall continue in force as appropriate until the latter of:

  • Coverage Period means the time period specified on the Declarations Page beginning on the effective date and ending on the expiration date. All dates are as of 12:01 AM in the time zone of the Policyholder.

  • Period of Coverage means the Plan Year, with the following exceptions: (a) for Employees who first become eligible to participate, it shall mean the portion of the Plan Year following the date on which participation commences, as described in Section 3.1; and (b) for Employees who terminate participation, it shall mean the portion of the Plan Year prior to the date on which participation terminates, as described in Section 3.2.

  • Denial means the process of refusing to grant a license after OCCL receives an application. This constitutes refusal of permission to operate.

  • Site Coverage means ratio expressed in percentage between the area covered by the ground floor of building and the area of the site;

  • Health care coverage means any plan providing hospital, medical or surgical care coverage for

  • Lot coverage means the portion or percentage of the area of a lot upon which buildings are erected.

  • Debt Service Coverage means that for every $1.00 of debt service required to be paid there must be $1.15 of Net Operating Income available. A worksheet for the calculation of Debt Service Coverage is found in the Report of Operations attached hereto as Exhibit "H" and incorporated herein by this reference.

  • Continuous period of creditable coverage means the period during which an individual was covered by creditable coverage, if during the period of the coverage the individual had no breaks in coverage greater than sixty-three (63) days.

  • Insurance score means a number or rating that is derived from an algorithm, computer application, model, or other process that is based in whole or in part on credit information for the purposes of predicting the future insurance loss exposure of a consumer.

  • Claims-made coverage means an insurance contract or provision limiting

  • Asset Coverage Test is met if the Adjusted Aggregate Asset Amount (as defined below) shall be in an amount at least equal to the Canadian Dollar Equivalent of the aggregate Principal Amount Outstanding of the Covered Bonds as calculated on the relevant Calculation Date. For greater certainty, references in this Schedule to “immediately preceding Calculation Date” and “previous Calculation Date” are to the Calculation Period ending on the Calculation Date.

  • Period of Insurance means the period commencing from the retroactive date and terminating on the expiry date as shown in the Policy Schedule.

  • Health insurance coverage means benefits consisting of medical care (provided directly, through

  • Interest Coverage Test means the Class A/B Interest Coverage Test, the Class C Interest Coverage Test, the Class D Interest Coverage Test and the Class E Interest Coverage Test.

  • Individual health insurance coverage means health insurance coverage offered to individuals in the

  • Group health insurance coverage means in connection with a group health plan, health insurance