Common use of Acute Care Services Appeals Clause in Contracts

Acute Care Services Appeals. If your request for pre-certification of acute care services is wholly or partially denied and you have not received such services or if you are currently receiving acute care services and a request for the extension of these services is wholly or partially denied, you or your authorized representative may submit an appeal of that denial within 180 calendar days after receiving notice that your request was denied. Your appeal can be submitted to PIC in writing, by telephone, or electronically, along with any issues, comments, and additional information, as appropriate. You have the right to present written evidence and telephonic testimony as part of the appeals process. When you appeal the initial determination for medical reasons, XXX will arrange for review of the clinical material by a physician who holds a current, unrestricted license to practice medicine, has the same or similar medical specialty as a provider that typically treats or manages the condition for which pre-certification of acute care services was requested and who did not make the initial determination. As quickly as your medical condition requires, but no later than 72 hours of PIC’s receipt of your appeal, you and your attending health care professional will receive telephone notice of PIC’s decision, including the specific reasons for it and the procedure for requesting an external review to the extent external review is required by law. This time period may be extended if you agree. Written notification will be sent to you and your attending health care professional within one business day of the determination, or sooner if your medical condition requires.

Acute Care Services Appeals. If your request for pre-certification of acute care services is wholly or partially denied and you have not received such services or if you are currently receiving acute care services and a request for the extension of these services is wholly or partially denied, you or your authorized representative may submit an appeal of that denial within 180 calendar days after receiving notice that your request was denied. Your appeal can be submitted to PIC in writing, by telephone, or electronically, along with any issues, comments, and additional information, as appropriate. You have the right to present written evidence and telephonic testimony as part of the appeals process. When you appeal the initial determination for medical reasons, XXX will arrange for review of the clinical material by a physician who holds a current, unrestricted license to practice medicine, has the same or similar medical specialty as a provider that typically treats or manages the condition for which pre-certification of acute care services was requested and who did not make the initial determination. As quickly as your medical condition requires, but no later than 72 hours of PIC’s receipt of your appeal, you and your attending health care professional will receive telephone notice of PIC’s decision, including the specific reasons for it and the procedure for requesting an external review to the extent external review is required by law. This time period may be extended if you agree. Written notification will be sent to you and your attending health care professional and within one business day of the determination, or sooner if your medical condition requires.

Acute Care Services Appeals. If your request for pre-certification of acute care services is wholly or partially denied and you have not received such services or if you are currently receiving acute care services and a request for the extension of these services is wholly or partially denied, you or your authorized representative may submit an appeal of that denial within 180 calendar days after receiving notice that your request was denied. Your appeal can be submitted to PIC in writing, by telephone, or electronically, along with any issues, comments, and additional information, as appropriate. You have the right to present written evidence and telephonic testimony as part of the appeals process. When you appeal the initial determination for medical reasons, XXX will arrange for review of the clinical material by a physician who holds a current, unrestricted license to practice medicine, has the same or similar medical specialty as a provider that typically treats or manages the condition for which pre-certification of acute care services was requested and who did not make the initial determination. As quickly as your medical condition requires, but no later than 72 hours of PIC’s receipt of your appeal, you and and, your attending health care professional will receive telephone notice of PIC’s decision, including the specific reasons for it and the procedure for requesting an external review to the extent external review is required by law. This time period may be extended if you agree. Written notification will be sent to you and your attending health care professional within one business day of the determination, or sooner if your medical condition requires.

Acute Care Services Appeals. If your request for pre-certification of acute care services is wholly or partially denied and you have not received such services or if you are currently receiving acute care services and a request for the extension of these services is wholly or partially denied, you or your authorized representative may submit an appeal of that denial within 180 calendar days after receiving notice that your request was denied. Your appeal can be submitted to PIC in writing, by telephone, or electronically, along with any issues, comments, and additional information, as appropriate. You have the right to present written evidence and telephonic testimony as part of the appeals process. When you appeal the initial determination for medical reasons, XXX will arrange for review of the clinical material by a physician who holds a current, unrestricted license to practice medicine, has the same or similar medical specialty as a provider that typically treats or manages the condition for which pre-certification of acute care services was requested and who did not make the initial determination. As quickly as your medical condition requires, but no later than 72 hours of PIC’s receipt of your appeal, you you, and your attending health care professional will receive telephone notice of PIC’s decision, including the specific reasons for it and the procedure for requesting an external review to the extent external review is required by law. This time period may be extended if you agree. Written notification will be sent to you and your attending health care professional within one business day of the determination, or sooner if your medical condition requires.

Acute Care Services Appeals. If your request for pre-certification of acute care services is wholly or partially denied and you have not received such services or if you are currently receiving acute care services and a request for the extension of these services is wholly or partially denied, you or your authorized representative may submit an appeal of that denial within 180 calendar days after receiving notice that your request was denied. Your appeal can be submitted to PIC in writing, by telephone, or electronically, along with any issues, comments, and additional information, as appropriate. You have the right to present written evidence and telephonic testimony as part of the appeals process. When you appeal the initial determination for medical reasons, XXX will arrange for review of the clinical material by a physician who holds a current, unrestricted license to practice medicine, has the same or similar medical specialty as a provider that typically treats or manages the condition for which pre-certification of acute care services was requested and who did not make the initial determination. As quickly as your medical condition requires, but no later than 72 hours of PIC’s receipt of your appeal, you and your attending health care professional will receive telephone notice of PIC’s decision, including the specific reasons for it and the procedure for requesting an external review to the extent external review is required by law. This time period may be extended if you agree. Written notification will be sent to you you, your and your attending health care professional within one business day of the determination, or sooner if your medical condition requires.