Common use of MEMBER NOTICE, APPEALS AND FAIR HEARINGS Clause in Contracts

MEMBER NOTICE, APPEALS AND FAIR HEARINGS. 8.6.1 HMO must send Members the notice required by 1 Texas Administrative Code Section 357.5, whenever HMO takes an action to deny, delay, reduce or terminate covered services to a Member. The notice must be mailed to the Member no less than 10 days before HMO intends to take an action. If an emergency exists, or if the time within which the service must be provided makes giving 10 days notice impractical or impossible, notice must be provided by the most expedient means reasonably calculated to provide actual notice to the Member, including by phone, direct contact with the Member, or through the provider's office.

MEMBER NOTICE, APPEALS AND FAIR HEARINGS. 8.6.1 8.7.1 HMO must send Members the notice required by 1 Texas Administrative Code Section ss. 357.5, whenever HMO takes an action to deny, delay, reduce or terminate covered services to a Member. The notice must be mailed to the Member no less than 10 days before HMO intends to take an action. If an emergency exists, or if the time within which the service must be provided makes giving 10 days notice impractical or impossible, notice must be provided by the most expedient means reasonably calculated to provide actual notice to the Member, including by phone, direct contact with the Member, or through the provider's office.

MEMBER NOTICE, APPEALS AND FAIR HEARINGS. 8.6.1 HMO must send Members the notice required by 1 Texas Administrative Code Section 357.5ss.357.5, whenever HMO takes an action to deny, delay, reduce or terminate covered services to a Member. The notice must be mailed to the Member no less than 10 days before HMO intends to take an action. If an emergency exists, or if the time within which the service must be provided makes giving 10 days notice impractical or impossible, notice must be provided by the most expedient means reasonably calculated to provide actual notice to the Member, including by phone, direct contact with the Member, or through the provider's office.

MEMBER NOTICE, APPEALS AND FAIR HEARINGS. 8.6.1 8.7.1 HMO must send Members the notice required by 1 Texas Administrative Code Section 357.5, whenever HMO takes an action to deny, delay, reduce or terminate covered services to a Member. The notice must be mailed to the Member no less than 10 days before HMO intends to take an action. If an emergency exists, or if the time within which the service must be provided makes giving 10 days notice impractical or impossible, notice must be provided by the most expedient means reasonably calculated to provide actual notice to the Member, including by phone, direct contact with the Member, or through the provider's office.

MEMBER NOTICE, APPEALS AND FAIR HEARINGS. 8.6.1 HMO must send Members the notice required by 1 Texas Administrative Code Section ss. 357.5, whenever HMO takes an action to deny, delay, reduce or terminate covered services to a Member. The notice must be mailed to the Member no less than 10 days before HMO intends to take an action. If an emergency exists, or if the time within which the service must be provided makes giving 10 days notice impractical or impossible, notice must be provided by the most expedient means reasonably calculated to provide actual notice to the Member, including by phone, direct contact with the Member, or through the provider's office.

MEMBER NOTICE, APPEALS AND FAIR HEARINGS. 8.6.1 8.7.1 HMO must send Members the notice required by 1 Texas Administrative Code Section 357.5ss.357.5, whenever HMO takes an action to deny, delay, reduce or terminate covered services to a Member. The notice must be mailed to the Member no less than 10 days before HMO intends to take an action. If an emergency exists, or if the time within which the service must be provided makes giving 10 days notice impractical or impossible, notice must be provided by the most expedient means reasonably calculated to provide actual notice to the Member, including by phone, direct contact with the Member, or through the provider's office.