Is the UM appeal process free?
It does not cost anything for a covered person, or a health care provider making an appeal on a covered person’s behalf, to file a UM appeal at Stage 1 or Stage 2. However, there is a modest filing fee for filing a Stage 3 (IHCAP) appeal. • What is the cost for making UM appeals through the IHCAP? There is a filing fee of $25.00 (which may be reduced to $2.00 if the appeal is filed by a covered person who can prove financial hardship). The review fee, which varies depending upon which Independent Utilization Review Organization reviews the case, is paid by the carrier. • Must a health care provider obtain consent from a patient in order to file a UM appeal with the IHCAP? Yes. A health care provider does not have an independent right to appeal an adverse UM determination. • When may a health care provider get consent from a patient to make a UM appeal on the patient’s behalf? As of July 11, 2006, a health care provider may obtain consent from a patient to appeal an adverse UM determina
