Common use of Member Notice of Grievance, Appeal and Fair Hearing Clause in Contracts

Member Notice of Grievance, Appeal and Fair Hearing. Procedures 1) benefits will continue if the member files an appeal or requests a FSSA fair hearing within the specified timeframes; and 2) the member may be required to pay the cost of services furnished during the appeal if the final decision is adverse to the member; The right to request an External Review by an Independent Review Organization of decisions listed in 4.9.4; and ▪ For a FSSA fair hearing: • The right to a hearing; • The method for obtaining a hearing; and • The rules that govern representation at the hearing.

Member Notice of Grievance, Appeal and Fair Hearing. Procedures 1) benefits will continue if the member files an appeal or requests a FSSA fair hearing within the specified timeframes; and 2) the member may be required to pay the cost of services furnished during the appeal if the final decision is adverse to the member; The right to request an External Review by an Independent Review Organization of decisions listed in 4.9.4; and ▪  For a FSSA fair hearing: •  The right to a hearing; •  The method for obtaining a hearing; and •  The rules that govern representation at the hearing.

Member Notice of Grievance, Appeal and Fair Hearing. Procedures 1) benefits will continue if the member files an appeal or requests a FSSA fair hearing within the specified timeframes; and 2) the member may be required to pay the cost of services furnished during the appeal if the final decision is adverse to the member; The right to request an External Review by an Independent Review Organization of decisions listed in 4.9.4; and ▪ For a FSSA fair hearing: • The right to a hearing; • The method for obtaining a hearing; and • The rules that govern representation at the hearing.