Examples of Review agent in a sentence
Within 5 business days after receiving a written appeal of the adverse determination, we or our Utilization Review agent will send you, your designated representative, or your unborn child’s physician or perinatal provider, a letter acknowledging the date of receipt of the appeal.
An adverse determination is a decision that is made by us or our Utilization Review agent that the health-care services furnished or proposed to be furnished to your unborn child are not medically necessary or appropriate.
When we or our Utilization Review agent deny the appeal, you, your designated representative, or you unborn child’s physician or perinatal provider will receive information on how to request an IRO review of the denial and the forms that must be completed and returned to begin the independent review process.
In life-threatening situations, you, your designated representative, or your unborn child’s physician or Perinatal provider of record may contact us or our Utilization Review agent by telephone to request the review by the IRO; and we or our Utilization Review agent will provide the required information.
The letter will also include a list of documents that you, your designated representative or your unborn child’s physician or prenatal care provider should send to us or to our Utilization Review agent for the appeal.