Common use of Grievance and Appeals Process Clause in Contracts

Grievance and Appeals Process. If you were charged cost sharing for coverage of PrEP medication or PrEP-related services on or after January 1, 2021, please call our customer service line at (000) 000-0000. If you would like to submit a grievance, the customer service representative can submit the request for you. If you are denied coverage of a PrEP-related service(s), we will inform you in writing of the denial. Our notice to you will explain why we denied the coverage and will provide you with instructions for filing a grievance if you want to contest our decision. You, your designee, prescribing physician or other prescriber can request a standard or expedited review of a PrEP coverage denial as follows: Phone: (000) 000-0000 or at 0-000-000-0000 Address: Presbyterian Health Plan Attn: Appeals and Grievance Department P.O. Box 27489 Albuquerque, NM 00000-0000 Fax: (000) 000-0000 Email: xxxxxxxx@xxx.xxx You may also contact the Managed Health Care Bureau (MHCB) at OSI for assistance with preparing a request for a review at: Address: Office of Superintendent of Insurance Managed Health Care Bureau P.O. Box 1689 Santa Fe, NM 87504-1689 Address: 0-000-000-0000 or 000-000-0000 Fax: (000) 000-0000 Email: xxxx.xxxxxxxxx@xxx.xx.xxx File a Complaint: xxxx://xxx.xxx.xxxxx.xx.xx/pages/misc/mhcb-complaint Exception Process If you have been denied coverage of a PrEP medication, we will inform you in writing of the denial. Our notice to you will provide you with instructions for filing an exception request if the medication that is most appropriate for your circumstances is not included in the drug Formulary. You, your designee, prescribing physician or other prescriber can request a standard or expedited review of a PrEP medication coverage denial by contacting Customer Service at the number on the back of your ID card.

Grievance and Appeals Process. If you were charged cost sharing for coverage of PrEP medication or PrEP-related services on or after January 11st, 2021, please call our customer service line at (000) 000505-0000923-5678. If you would like to submit a grievance, the customer service representative can submit the request for you. If you are denied coverage of a PrEP-related service(s), we will inform you in writing of the denial. Our notice to you will explain why we denied the coverage and will provide you with instructions for filing a grievance if you want to contest our decision. You, your designee, prescribing physician or other prescriber can request a standard or expedited review of a PrEP coverage denial as followsby contacting customer service at: Phone: (000) 000-0000 or at 0-000-000-0000 0000‌‌ Address: Presbyterian Health Plan Attn: Appeals and Grievance Department P.O. Box 27489 Albuquerque, NM 00000-0000 Fax: (000) 000-0000 Email: xxxxxxxx@xxx.xxx You may also contact the Managed Health Care Bureau (MHCB) at OSI for assistance with preparing a request for a review at: Phone: (000) 000-0000 or 0-000-000-0000 Address: Office of Superintendent of Insurance Managed Health Care Bureau P.O. Box 1689 Santa - MHCB X.X. Xxx 1689, 0000 Xxxxx xx Xxxxxxx Xxxxx Fe, NM 87504-1689 Address: 0-000-000-0000 or 000-00000000-0000 Fax: (000) 000-0000 0000, Attn: MHCB Email: xxxx.xxxxxxxxx@xxx.xx.xxx File a Complaint: xxxx://xxx.xxx.xxxxx.xx.xx/pages/misc/mhcb-complaint xxxx.xxxxxxxxx@xxxxx.xx.xx Exception Process If you have been denied coverage of a PrEP medication, we will inform you in writing of the denial. Our notice to you will provide you with instructions for filing an exception request if the medication that is most appropriate for your circumstances is not included in the drug Formularyformulary. You, your designee, prescribing physician or other prescriber can request a standard or expedited review of a PrEP medication coverage denial by contacting Customer Service at the number on the back of your ID card. Standard Review • We will review your request and issue a determination to you, your designee, prescribing physician or other prescriber, within72 hours following receipt of your request.

Grievance and Appeals Process. If you were charged cost sharing for coverage of PrEP medication or PrEP-related services on or after January 11st, 2021, please call our customer service line at (000) 000505-0000923-5678. If you would like to submit a grievance, the customer service representative can submit the request for you. If you are denied coverage of a PrEP-related service(s), we will inform you in writing of the denial. Our notice to you will explain why we denied the coverage and will provide you with instructions for filing a grievance if you want to contest our decision. You, your designee, prescribing physician or other prescriber can request a standard or expedited review of a PrEP coverage denial as followsby contacting customer service at: Phone: (000) 000-0000 or at 0-000-000-0000 Address: Presbyterian Health Plan Attn: Appeals and Grievance Department P.O. Box 27489 Albuquerque, NM 00000-0000 Fax: (000) 000-0000 Email: xxxxxxxx@xxx.xxx You may also contact the Managed Health Care Bureau (MHCB) at OSI for assistance with preparing a request for a review at: Phone: (000) 000-0000 or 0-000-000-0000 Address: Office of Superintendent of Insurance Managed Health Care Bureau - MHCB P.O. Box 1689 Santa 1689, 0000 Xxxxx xx Xxxxxxx Xxxxx Fe, NM 87504-1689 Address: 0-000-000-0000 or 000-00000000-0000 Fax: (000) 000-0000 0000, Attn: MHCB Email: xxxx.xxxxxxxxx@xxx.xx.xxx File a Complaint: xxxx://xxx.xxx.xxxxx.xx.xx/pages/misc/mhcb-complaint xxxx.xxxxxxxxx@xxxxx.xx.xx Exception Process If you have been denied coverage of a PrEP medication, we will inform you in writing of the denial. Our notice to you will provide you with instructions for filing an exception request if the medication that is most appropriate for your circumstances is not included in the drug Formularyformulary. You, your designee, prescribing physician or other prescriber can request a standard or expedited review of a PrEP medication coverage denial by contacting Customer Service at the number on the back of your ID card. Standard Review • We will review your request and issue a determination to you, your designee, prescribing physician or other prescriber, within72 hours following receipt of your request.

Grievance and Appeals Process. If you were charged cost sharing for coverage of PrEP medication or PrEP-related services on or after January 11st, 2021, please call our customer service line at (000) 000505-0000923-5678. If you would like to submit a grievance, the customer service representative can submit the request for you. If you are denied coverage of a PrEP-related service(s), we will inform you in writing of the denial. Our notice to you will explain why we denied the coverage and will provide you with instructions for filing a grievance if you want to contest our decision. You, your designee, prescribing physician or other prescriber can request a standard or expedited review of a PrEP coverage denial as followsby contacting customer service at: Phone: (000) 000-0000 or at 0-000-000-0000 Address: Presbyterian Health Plan Attn: Appeals and Grievance Department P.O. Box 27489 AlbuquerqueX.X. Xxx 00000 Xxxxxxxxxxx, NM XX 00000-0000 Fax: (000) 000-0000 Email: xxxxxxxx@xxx.xxx You may also contact the Managed Health Care Bureau (MHCB) at OSI for assistance with preparing a request for a review at: Phone: (000) 000-0000 or 0-000-000-0000 Address: Office of Superintendent of Insurance Managed Health Care Bureau - MHCB P.O. Box 1689 Santa 1689, 0000 Xxxxx xx Xxxxxxx Xxxxx Fe, NM 87504-1689 Address: 0-000-000-0000 or 000-00000000-0000 Fax: (000) 000-0000 0000, Attn: MHCB Email: xxxx.xxxxxxxxx@xxx.xx.xxx File a Complaint: xxxx://xxx.xxx.xxxxx.xx.xx/pages/misc/mhcb-complaint xxxx.xxxxxxxxx@xxxxx.xx.xx Exception Process If you have been denied coverage of a PrEP medication, we will inform you in writing of the denial. Our notice to you will provide you with instructions for filing an exception request if the medication that is most appropriate for your circumstances is not included in the drug Formularyformulary. You, your designee, prescribing physician or other prescriber can request a standard or expedited review of a PrEP medication coverage denial by contacting Customer Service at the number on the back of your ID card. Standard Review • We will review your request and issue a determination to you, your designee, prescribing physician or other prescriber, within72 hours following receipt of your request.

Grievance and Appeals Process. If you were charged cost sharing for coverage of PrEP medication or PrEP-related services on or after January 11st, 2021, please call our customer service line at (000) 000-0000. If you would like to submit a grievance, the customer service representative can submit the request for you. If you are denied coverage of a PrEP-related service(s), we will inform you in writing of the denial. Our notice to you will explain why we denied the coverage and will provide you with instructions for filing a grievance if you want to contest our decision. You, your designee, prescribing physician or other prescriber can request a standard or expedited review of a PrEP coverage denial as follows: Phone: (000) 000-0000 or at 0-000-000-0000 Address: Presbyterian Health Plan Attn: Appeals and Grievance Department P.O. Box 27489 Albuquerque, NM 00000-0000 Fax: (000) 000-0000 Email: xxxxxxxx@xxx.xxx You may also contact the Managed Health Care Bureau (MHCB) at OSI for assistance with preparing a request for a review at: Phone: (000) 000-0000 or 0-000-000-0000 Address: Office of Superintendent of Insurance Managed Health Care Bureau - MHCB P.O. Box 1689 1689, Santa Fe, NM 87504-1689 Address: 0-000-000-0000 or 000-00000000-0000 Fax: (000) 000-0000 0000, Attn: MHCB Email: File complaint: xxxx.xxxxxxxxx@xxx.xx.xxx File a Complaint: xxxx://xxx.xxx.xxxxx.xx.xx/pages/misc/mhcb-complaint Exception Process If you have been denied coverage of a PrEP medication, we will inform you in writing of the denial. Our notice to you will provide you with instructions for filing an exception request if the medication that is most appropriate for your circumstances is not included in the drug Formulary. You, your designee, prescribing physician or other prescriber can request a standard or expedited review of a PrEP medication coverage denial by contacting Customer Service at the number on the back of your ID card.

Grievance and Appeals Process. If you were charged cost sharing for coverage of PrEP medication or PrEP-related services on or after January 11st, 2021, please call our customer service line at (000) 000-0000. If you would like to submit a grievance, the customer service representative can submit the request for you. If you are denied coverage of a PrEP-related service(s), we will inform you in writing of the denial. Our notice to you will explain why we denied the coverage and will provide you with instructions for filing a grievance if you want to contest our decision. You, your designee, prescribing physician or other prescriber can request a standard or expedited review of a PrEP coverage denial as follows: Phone: (000) 000-0000 or at 0-000-000-0000 Address: Presbyterian Health Plan Attn: Appeals and Grievance Department P.O. Box 27489 Albuquerque, NM 00000-0000 Fax: (000) 000-0000 Email: xxxxxxxx@xxx.xxx You may also contact the Managed Health Care Bureau (MHCB) at OSI for assistance with preparing a request for a review at: Phone: (000) 000-0000 or 0-000-000-0000 Address: Office of Superintendent of Insurance Managed Health Care Bureau P.O. Box 1689 Santa - MHCB X.X. Xxx 1689, 0000 Xxxxx xx Xxxxxxx Xxxxx Fe, NM 87504-1689 Address: 0-000-000-0000 or 000-00000000-0000 Fax: (000) 000-0000 0000, Attn: MHCB Email: xxxx.xxxxxxxxx@xxx.xx.xxx File a Complaint: xxxx://xxx.xxx.xxxxx.xx.xx/pages/misc/mhcb-complaint xxxx.xxxxxxxxx@xxxxx.xx.xx Exception Process If you have been denied coverage of a PrEP medication, we will inform you in writing of the denial. Our notice to you will provide you with instructions for filing an exception request if the medication that is most appropriate for your circumstances is not included in the drug Formularyformulary. You, your designee, prescribing physician or other prescriber can request a standard or expedited review of a PrEP medication coverage denial by contacting Customer Service at the number on the back of your ID card. Standard Review • We will review your request and issue a determination to you, your designee, prescribing physician or other prescriber, within72 hours following receipt of your request.

Grievance and Appeals Process. If you were charged cost sharing for coverage of PrEP medication or PrEP-related services on or after January 1, 2021, please call our customer service line at (000) 000000)000-0000. If you would like to submit a grievance, the customer service representative can submit the request for you. If you are denied coverage of a PrEP-related service(s), we will inform you in writing of the denial. Our notice to you will explain why we denied the coverage and will provide you with instructions for filing a grievance if you want to contest our decision. You, your designee, prescribing physician or other prescriber can request a standard or expedited review of a PrEP coverage denial as follows: Phone: (000) 000-0000 or at 0-000-000-0000 Address: Presbyterian Health Plan Attn: Appeals and Grievance Department P.O. Box 27489 Albuquerque, NM 00000-0000 Fax: (000) 000-0000 Email: xxxxxxxx@xxx.xxx You may also contact the Managed Health Care Bureau (MHCB) at OSI for assistance with preparing a request for a review at: Address: Office of Superintendent of Insurance Managed Health Care Bureau P.O. Box 1689 Santa Fe, NM 87504-1689 Address: 0-000-000-0000 or 000-000-0000 Fax: (000) 000-0000 Email: xxxx.xxxxxxxxx@xxx.xx.xxx File a Complaint: xxxx://xxx.xxx.xxxxx.xx.xx/pages/misc/mhcb-complaint Exception Process If you have been denied coverage of a PrEP medication, we will inform you in writing of the denial. Our notice to you will provide you with instructions for filing an exception request if the medication that is most appropriate for your circumstances is not included in the drug Formulary. You, your designee, prescribing physician or other prescriber can request a standard or expedited review of a PrEP medication coverage denial by contacting Customer Service at the number on the back of your ID card. Standard Review  We will review your request and issue a determination to you, your designee, prescribing physician or other prescriber, within 72 hours following receipt of your request.

Grievance and Appeals Process. If you were charged cost sharing for coverage of PrEP medication or PrEP-related services on or after January 1, 2021, please call our customer service line at (000) 000-0000. If you would like to submit a grievance, the customer service representative can submit the request for you. If you are denied coverage of a PrEP-related service(s), we will inform you in writing of the denial. Our notice to you will explain why we denied the coverage and will provide you with instructions for filing a grievance if you want to contest our decision. You, your designee, prescribing physician or other prescriber can request a standard or expedited review of a PrEP coverage denial as follows: Phone: (000) 000-0000 or at 0-000-000-0000 Address: Presbyterian Health Plan Attn: Appeals and Grievance Department P.O. Box 27489 Albuquerque, NM 00000-0000 Fax: (000) 000-0000 Email: xxxxxxxx@xxx.xxx You may also contact the Managed Health Care Bureau (MHCB) at OSI for assistance with preparing a request for a review at: Phone: (000) 000-0000 or 0-000-000-0000 Address: Office of Superintendent of Insurance Managed Health Care Bureau - MHCB P.O. Box 1689 1689, Santa Fe, NM 87504-1689 Address: 0-000-000-0000 or 000-00000000-0000 Fax: (000) 000-0000 0000, Attn: MHCB Email: xxxx.xxxxxxxxx@xxx.xx.xxx File a Complaintxxxx://xxx.xxx.xxxxx.xx.xx/pages/misc/mhcb-complaint complaint: xxxx://xxx.xxx.xxxxx.xx.xx/pages/misc/mhcb-complaint Exception Process If you have been denied coverage of a PrEP medication, we will inform you in writing of the denial. Our notice to you will provide you with instructions for filing an exception request if the medication that is most appropriate for your circumstances is not included in the drug Formulary. You, your designee, prescribing physician or other prescriber can request a standard or expedited review of a PrEP medication coverage denial by contacting Customer Service at the number on the back of your ID card.card.‌‌