Notice of review. Unless you choose not to pursue the Grievance, we shall notify you of the date, time, and place of the internal panel review. The notice shall advise you of the rights specified in the Right of Grievant in this section. If we indicate that we will have an attorney represent our interests, the notice shall advise you that an attorney will represent us and that you may wish to obtain legal representation of your own. Panel membership. We shall select one or more representatives of our Company and one or more health care or other professionals who have not been previously involved in the Adverse Determination being reviewed to serve on the internal review panel. At least one of the Health Care Professionals selected shall practice in a specialty that would typically manage the case that is the subject of the Grievance or be mutually agreed upon by you and us. Scope of review
Appears in 5 contracts
Samples: Group Subscriber Agreement, Presbyterian Health Plan, Presbyterian Health Plan
Notice of review. Unless you choose not to pursue the Grievance, we shall notify you of the date, time, and place of the internal panel review. The notice shall advise you of the rights specified in the Right of Grievant in this section. If we indicate that we will have an attorney represent our interests, the notice shall advise you that an attorney will represent us and that you may wish to obtain legal representation of your own. ⮚ Panel membership. We shall select one or more representatives of our Company and one or more health care or other professionals who have not been previously involved in the Adverse Determination being reviewed to serve on the internal review panel. At least one of the Health Care Professionals selected shall practice in a specialty that would typically manage the case that is the subject of the Grievance or be mutually agreed upon by you and us. ⮚ Scope of review
Appears in 2 contracts
