What if I’m not satisfied with the decision PacificSource makes on my grievance or appeal?
Along with notice of our decision, we will provide you with information on how to file an appeal at the next level. Under certain circumstances, you may have the right to have your case reviewed by an external independent review organization to dispute our decision on your appeal. If we denied benefits because we determined that services were not medically necessary or were experimental or investigational, you have this right. In addition, if you believe you have a right to continue treatment with a provider who is no longer eligible for payment by us, your appeal may be reviewed externally. Your request for an independent review must be made within 180 days after you receive our final decision. External independent review is available at no cost to you, but is only an option for issues of medical necessity, experimental or investigational treatment, and continuity of care after all internal grievance levels are exhausted.
