Common use of Level Dental Necessity Appeals Clause in Contracts

Level Dental Necessity Appeals. If You are not satisfied with the original decision, a written request to Appeal must be submitted within one hundred eighty (180) days of the initial Adverse Benefit Determination for first level Dental Necessity Appeals. Requests submitted to UCD after one hundred eighty (180) days of the initial Adverse Benefit Determination will not be considered. UCD will investigate Your concerns. If the Dental Necessity Appeal is overturned, UCD will reprocess Your Claim, if any. If the Dental Necessity Appeal is upheld, UCD will inform You of the right to begin the second level Dental Necessity Appeal process. The Dental Necessity Appeal decision will be mailed to You, Your authorized representative, or a Provider authorized by You to act on Your behalf, within thirty (30) days of receipt of Your request; unless it is mutually agreed that an extension of time is warranted.

Appears in 2 contracts

Samples: Individual Dental Contract, Individual Dental Contract

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Level Dental Necessity Appeals. If You are a Member is not satisfied with the original decision, a written request to Appeal must be submitted within one hundred eighty (180) days of the initial Adverse Benefit Determination for first level Dental Necessity Appeals. Requests submitted to UCD after one hundred eighty (180) days of receipt of the initial Adverse Benefit Determination will not be considered. UCD will investigate Your the Member’s concerns. If the Dental Necessity Appeal is overturned, UCD will reprocess Your the Member’s Claim, if any. If the Dental Necessity Appeal is upheld, UCD will inform You the Member of the right to begin the second level Dental Necessity Appeal process. The Dental Necessity Appeal decision will be mailed to Youthe Member, Your his authorized representative, or a Provider authorized by You to act on Your the Member’s behalf, within thirty (30) days of receipt of Your the Member’s request; unless it is mutually agreed that an extension of time is warranted.

Appears in 2 contracts

Samples: Limited Benefit Contract, Limited Benefit Contract

Level Dental Necessity Appeals. If You are not satisfied with the original decision, a written request to Appeal must be submitted within one hundred eighty (180) days of the initial Adverse Benefit Determination for first level Dental Necessity Appeals. Requests submitted to UCD after one hundred eighty (180) days of receipt of the initial Adverse Benefit Determination will not be considered. UCD will investigate Your concerns. If the Dental Necessity Appeal is overturned, UCD will reprocess Your Claim, if any. If the Dental Necessity Appeal is upheld, UCD will inform You of the right to begin the second level Dental Necessity Appeal process. The Dental Necessity Appeal decision will be mailed to You, Your authorized representative, or a Provider authorized by You to act on Your behalf, within thirty (30) days of receipt of Your request; unless it is mutually agreed that an extension of time is warranted.

Appears in 1 contract

Samples: Limited Benefit Contract

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Level Dental Necessity Appeals. If You are not satisfied with the original decision, a written request to Appeal must be submitted within one hundred eighty (180) days of the initial Adverse Benefit Determination for first level Dental Necessity Appeals. Requests submitted to UCD after one hundred eighty (180) days of receipt of the initial Adverse Benefit Determination will not be considered. UCD will investigate Your concerns. If the Dental Necessity Appeal is overturned, UCD will reprocess Your Claim, if any. If the Dental Necessity Appeal is upheld, UCD will inform You of the Your right to begin the second level Dental Necessity Appeal process. The Dental Necessity Appeal decision will be mailed to You, Your authorized representative, or a Provider authorized by You to act on Your behalf, within thirty (30) days of receipt of Your request; unless it is mutually agreed that an extension of time is warranted.

Appears in 1 contract

Samples: Limited Benefit Contract

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