Common use of Expedited Appeal Clause in Contracts

Expedited Appeal. An expedited appeal may be submitted orally or in writing. All necessary information, including our determination on review, will be transmitted between the member and us by telephone, facsimile, or other available similarly expeditious method. An expedited appeal shall be resolved as expeditiously as the member’s health condition requires but not more than 24 hours after receipt of the grievance. Due to the 24-hour resolution timeframe, the standard requirements for notification, grievance panel, and acknowledgement do not apply. The provider who recommended the service and/or the member’s PCP, along with the member, shall be notified orally of the decision followed-up by a written notice of the determination. Upon written request, we will mail or electronically mail a copy of the member’s complete contract to the member or the member’s authorized representative as expeditiously as the expedited appeal is handled.