Purchaser’s Grievance and Appeal Procedures. Purchaser has furnished Provider with a copy of its approved grievance and appeal procedures in Attachment [X]. In the event that a member complains directly to the Provider, the member must be given a copy of these procedures which contains information related to: a. The member’s right to a fair hearing, how to obtain a hearing and representation rules at a hearing; b. The member’s right to file grievances and appeals and their requirement and timeframes for filing; c. The availability of assistance in filing; d. Numbers to file oral grievance and appeals; e. The member’s right to request continuation of benefits during an appeal or fair hearing filing, and, if the information that if the appeal is upheld in a hearing, the member may be liable for the cost of any continued benefits, and; f. The member’s appeals right to challenge the failure of the Purchaser to cover a service.
Appears in 4 contracts
Samples: Provider Purchase of Services Contract, Service Provider Contract, Service Provider Contract
