My Health Plan Offers Two Levels Of Internal Appeals. Must I File A Second Appeal With My Health Plan Before Requesting An External Appeal?
• No. Your health plan may not require you to exhaust a second level of internal appeal to be eligible for an external appeal. In fact, the 45-day time limit to file an external appeal begins upon receipt of the final adverse determination from the first-level appeal with your health plan. So by choosing a second-level appeal with your health plan, the time may expire for you to request an external appeal. Since The Timeframe To Request an External Appeal is 45 Days From When I Received The Determination From The First Level Of Appeal With My Health Plan, How Will The Insurance Department Know When I Received The Determination? • It will be presumed that you received the final adverse determination within 8 days of the date on the determination, so that you will have 53 days (45 + 8) from the date on the final adverse determination to request an external appeal. • You will not be provided additional time if you do not pick up your mail from a Post Office Box, or if you are away from ho
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