Common use of Expedited Dental Necessity Appeals Clause in Contracts

Expedited Dental Necessity Appeals. An Expedited Appeal process is available for review of the Adverse Benefit Determination involving a situation where the time frame of the standard Dental Necessity Appeal would seriously jeopardize Your life, health or ability to regain maximum function. It includes a situation where, in the opinion of the treating Provider, You may experience pain that cannot be adequately controlled while awaiting a standard Dental Necessity Appeal decision. An Expedited Appeal shall be made available to, and may be initiated by You, Your authorized representative, or a Provider authorized to act on Your behalf. Requests for an Expedited Appeal may be verbal or written. UCD will make a decision no later than seventy-two (72) hours of receipt of an Expedited Appeal. You may contact the Commissioner of Insurance directly for assistance: Commissioner of Insurance P. O. Box 94214 Baton Rouge, LA 70804-9214 0-000-000-0000 or 0-000-000-0000 LLHIGA NOTICE SUMMARY OF THE LOUISIANA LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION ACT AND NOTICE CONCERNING COVERAGE LIMITATIONS AND EXCLUSIONS

Expedited Dental Necessity Appeals. An Expedited Appeal process is available for review of the Adverse Benefit Determination involving a situation where the time frame of the standard Dental Necessity Appeal would seriously jeopardize Your life, health or ability to regain maximum function. It includes a situation where, in the opinion of the treating Provider, You may experience pain that cannot be adequately controlled while awaiting a standard Dental Necessity Appeal decision. An Expedited Appeal shall be made available to, and may be initiated by You, Your authorized representative, or a Provider authorized to act on Your behalf. Requests for an Expedited Appeal may be verbal or written. UCD will make a decision no later than seventy-two (72) hours of receipt of an Expedited Appeal. You may contact the Commissioner of Insurance directly for assistance: Commissioner of Insurance P. O. Box 94214 Baton Rouge, LA 70804-9214 0-000-000-0000 or 0-000-000-0000 LLHIGA NOTICE NOTICE‌ SUMMARY OF THE LOUISIANA LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION ACT AND NOTICE CONCERNING COVERAGE LIMITATIONS AND EXCLUSIONS

Expedited Dental Necessity Appeals. An Expedited Appeal process is available for review of the Adverse Benefit Determination involving a situation where the time frame of the standard Dental Necessity Appeal would seriously jeopardize Your life, health or ability to regain maximum function. It includes a situation where, in the opinion of the treating Provider, You may experience pain that cannot be adequately controlled while awaiting a standard Dental Necessity Appeal decision. An Expedited Appeal shall be made available to, and may be initiated by You, Your authorized representative, or a Provider authorized to act on Your behalf. Requests for an Expedited Appeal may be verbal or written. UCD will make a decision no later than seventy-two (72) hours of receipt of an Expedited Appeal. You may contact the Commissioner of Insurance directly for assistance: Commissioner of Insurance P. O. Box 94214 Baton Rouge, LA 70804-9214 0-000-000-0000 or 0-000-000-0000 97176EX-039 R01/21 41 LLHIGA NOTICE NOTICE‌ SUMMARY OF THE LOUISIANA LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION ACT AND NOTICE CONCERNING COVERAGE LIMITATIONS AND EXCLUSIONS

Expedited Dental Necessity Appeals. An Expedited Appeal process is available for review of the Adverse Benefit Determination involving a situation where the time frame of the standard Dental Necessity Appeal would seriously jeopardize Your life, health or ability to regain maximum function. It includes a situation where, in the opinion of the treating Provider, You may experience pain that cannot be adequately controlled while awaiting a standard Dental Necessity Appeal decision. An Expedited Appeal shall be made available to, and may be initiated by You, Your authorized representative, or a Provider authorized to act on Your behalf. Requests for an Expedited Appeal may be verbal or written. UCD will make a decision no later than seventy-two seventy -two (72) hours of receipt of an Expedited Appeal. You may contact the Commissioner of Insurance directly for assistance: Commissioner of Insurance P. O. Box 94214 Baton Rouge, LA 70804-9214 0-000-000-0000 or 0-000-000-0000 LLHIGA NOTICE SUMMARY OF THE LOUISIANA LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION ACT AND NOTICE CONCERNING COVERAGE LIMITATIONS AND EXCLUSIONS