Appeals
An appeal is when you ask for a formal hearing when you do not agree with a decision made by your health plan. You have the right to appeal when your health plan:
- Denies or limits a service approval request
- Does not approve a service in an amount length of time, or scope that you requested
- Denies payment for a service
- Suspends, reduces, discontinues, or terminates services
- Doesn’t act upon your grievance or appeal within required timeframes
- Denies your request to disagree with a bill
Requesting an appeal with your health plan:
- Contact a member representative from your health plan by phone or mail
- The member handbook from your health plan tells you how to file an appeal
- You have sixty (60) days from the date on your notice of adverse benefit determination to request an appeal with your health plan
- Your health plan must continue your benefits if you request to continue benefits and file your appeal with the health plan on time. The services also have to have been ordered by an authorized provider and your authorization period must not have run out.
- You may represent yourself at this hearing or be represented by another person
More information is available in the member handbooks for your plan at the following links:
Requesting a State Fair Hearing:
- You can request a State Fair Hearing after your appeal to the health plan has been finalized
- You must send the appeal request for a State Fair Hearing in writing
- Send your appeal request to:
Department of Health and Human Services MLTC Appeal Coordinator
PO Box 94967
Lincoln, NE 68509-4967 - You have 120 days from the date on the notice of resolution for the health plan appeal to request a State Fair Hearing.
- Once you have filed the appeal request for a State Fair Hearing, a hearing will be scheduled and you will be notified of the time and place
- You may represent yourself at this hearing or be represented by another person