Common use of Level Two Appeal Clause in Contracts

Level Two Appeal. If you are dissatisfied with our level one appeal decision, you may request a second review. To initiate a level two appeal, follow the same process required for a level one appeal, except that such request must be submitted within sixty (60) days from your receipt of a Level One Appeal decision. Requests for a second review will be acknowledged in writing within ten (10) business days, noting that we have received your request. Post-service requests will be completed within thirty (30) calendar days, while most pre- service requests will be completed within fifteen (15) calendar days. If more time or information is needed to make the determination, we will notify you in writing to request an extension of up to fifteen (15) calendar days and to specify any additional information needed to complete the review. You will be notified in writing of the decision. We will respond in writing with a decision as soon as possible in accordance to the medical needs of the case, not to exceed 72 hours in the case of appeals from determination regarding urgent or emergency care, an admission, availability of care, continued stay, health care services for which the claimant received emergency services but has not been discharged from a facility.