Common use of Second Level Administrative Appeals Clause in Contracts

Second Level Administrative Appeals. After review of Our first level Appeal decision, if a Member is still dissatisfied, a written request to Appeal must be submitted within sixty (60) days of Our first level Appeal decision. Requests submitted to Us after sixty (60) days of Our first level Appeal decision will not be considered. A Member Appeals Committee of persons not involved in previous decisions regarding the initial Adverse Benefit Determination will review the second level Appeals. The Committee’s decision is final and binding. The Committee’s decision will be mailed to the Member, his authorized representative, or a Provider authorized to act on the Member’s behalf, within five (5) days of the Committee meeting. Second Level Administrative Appeals are not applicable to a Rescission of Coverage, which follows the External Appeals track.

Second Level Administrative Appeals. After review of Our first level Appeal decision, if If a Member is still dissatisfieddisagrees with Our decision, a written request to Appeal must be submitted within sixty (60) days of Our first level Appeal decision. Requests submitted to Us after sixty (60) days of Our first level Appeal decision will not be considered. A Member Appeals Committee of persons not involved in previous decisions regarding the initial Adverse Benefit Determination will review the second level Appeals. The Committee’s decision is final and binding. The Committee’s decision will be mailed to the Member, his authorized representative, or a Provider authorized to act on the Member’s behalf, within five (5) days of the Committee meeting. Second Level Administrative Appeals are not applicable to a Rescission of Coverage, which follows the External Appeals track.

Second Level Administrative Appeals. After review of Our first level Appeal decision, if a Member is still dissatisfied, a written request to Appeal must be submitted within sixty (60) days of Our first level Appeal decision. Requests submitted to Us after sixty (60) days of Our first level Appeal decision will not be considered. A Member Appeals Committee of persons not involved in previous decisions regarding the initial Adverse Benefit Determination will review the second level Appeals. The Committee’s decision is final and binding. The Committee’s decision will be mailed to the Member, his authorized representative, or a Provider authorized Authorized to act on the Member’s behalf, within five (5) days of the Committee meeting. Second Level Administrative administrative Appeals are not applicable to a Rescission of CoverageRescission, which follows the External Appeals track.

Second Level Administrative Appeals. After review of Our first level Appeal decision, if a Member is still dissatisfied, a written request to Appeal must be submitted within sixty (60) days of Our first level Appeal decision. Requests submitted to Us after sixty (60) days of Our first level Appeal decision will not be considered. A Member Appeals Committee of persons not involved in previous decisions regarding the initial Adverse Benefit Determination will review the second level Appeals. The Committee’s decision is final and binding. The Committee’s decision will be mailed to the Member, his authorized representative, or a Provider authorized Authorized to act on the Member’s behalf, within five (5) days of the Committee meeting. Second Level Administrative Appeals are not applicable to a Rescission of Coverage, which follows the External Appeals track.