Common use of Second Level Appeal Clause in Contracts

Second Level Appeal. If you file a first level appeal (including pre-certification under CareCheck®) and it is denied, wholly or in part, you have the right to request external review of our decision without filing a second level appeal. See below for a description of this process. If your appeal does not involve a determination of medical necessity of Precertification, at your option, you or your authorized representative may, within 180 days of denial submit a written request for a second level appeal, including any relevant documents, and submit issues, comments and additional information as appropriate to: GHI Member Services Department 0000 00xx Xxxxxx Xxxxx P.O. Box 9463 Minneapolis, MN 00000-0000 Telephone: (000) 000-0000 Outside the metro area: 0-000-000-0000 The Member Services Department will provide the complainant with the option of either a written reconsideration, or a hearing before the Member Appeals Committee either in person or over the telephone. Hearings and written reconsiderations shall include the receipt of testimony, correspondence, explanations, or other information from the complainant, staff persons, administrators, providers, or other persons, as is deemed necessary for a fair appraisal and resolution of the appeal. During your appeal, upon your request we will provide you, free of charge, reasonable access to all documents, records and other information relevant to your appeal. We will review your appeal and written notice of the decision and all key findings will be given to the complainant within 30 calendar days of the Member Services Department’s receipt of the complainant’s written notice of appeal and request for written reconsideration. These time periods may be extended if you agree.