Member Appeal definition

Member Appeal means a request for a review of an action in accordance with 42 CFR 438.400, and for a person with an SMI, an appeal of an SMI eligibility determination; decisions regarding eligibility for behavioral health services, including Title XIX services, fees and waivers; assessments and further evaluations; service and treatment plans and planning decisions; and the implementation of those decisions.
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Examples of Member Appeal in a sentence

  • The Member can request an expedited/urgent appeal in writing to the above address, or by calling KFHPWA’s Member Appeal Department toll-free ▇-▇▇▇-▇▇▇-▇▇▇▇.

  • The most current information about your appeals process is available by contacting KFHPWA’s Member Appeal Department at the address or telephone number below.

  • Appeals should be directed to KFHPWA’s Member Appeal Department, ▇.▇.

  • You can use the Member Appeal Form, which a Customer Service Representative can provide to you, or you can send us a letter with the information requested above.

  • If the Member or any representative authorized in writing by the Member wishes to appeal a KFHPWA decision to deny, modify, reduce or terminate coverage of or payment for health care services, they must submit a request for an appeal either orally or in writing to KFHPWA’s Member Appeal Department, specifying why they disagree with the decision.

  • If the Member or the Member’s legal representative wishes to appeal a KFHPWA decision to deny, modify, reduce or terminate coverage of or payment for health care services, he/she must submit a request for an appeal either orally or in writing to KFHPWA’s Member Appeal Department, specifying why he/she disagrees with the decision.

  • Appeals regarding KFHPWA denial of coverage can be submitted to the Member Appeal Department, or to KFHPWA's medical director at ▇.▇.

  • Appeals should be directed to KFHPWA’s Member Appeal Department, P.O. Box 34593, Seattle, WA 98124- 1593, toll-free ▇-▇▇▇-▇▇▇-▇▇▇▇.

  • Appeals should be directed to Group Health’s Member Appeal Department, ▇.▇.

  • You have the right to appeal any decisions through the Member Appeal Process.