Common use of Your Right to an External Appeal Clause in Contracts

Your Right to an External Appeal. Under certain circumstances, you have a right to an external appeal of a denial of coverage. Specifically, if Fidelis has denied coverage on the basis that the service is not medically necessary or is an experimental or investigational treatment, you or your representative may appeal that decision to an External Appeal Agent, an independent entity certified by the State to conduct such appeals.

Appears in 4 contracts

Samples: Child Health Plus Contract, Child Health Plus Contract, Child Health Plus Contract

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