Xxxxxx a complaint appeals. If you are not satisfied with the resolution of a complaint, you may file an appeal. Your appeal must be filed within sixty (60) business days after receiving the response to your complaint. Appeals must be in writing, either by letter or on an appeal form available from Member Services. Member Services staff can help you fill out the form. You may send your appeal to: Fidelis Care You will receive a letter from Member Services letting you know that your appeal has been received. All appeals are sent to the Appeals Committee. The Appeals Committee makes a final decision on the appeal. You will get a letter of this decision after the final decision is made. The appeals decisions are made by people who are different from the people who made the first decision. All decisions about clinical appeals are made by qualified doctors and nurses. A letter will be sent to you to explain the decision and give you information about what the decision was based on. For example a medical textbook may be used to make a decision about the acceptable treatments for a disease. Appeals shall be decided and notification provided to you no more than:
Appears in 4 contracts
Samples: Health Plus Subscriber Contract, Health Plus Subscriber Contract, Health Plus Subscriber Contract
