Medicare Part C Benefits: File an Appeal
Category: File an Appeal
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If you have problems getting coverage for medical care or if you want us to pay you back for our share of the cost of your care you can file an appeal. If we say no to your request for coverage for medical care, we have a formal procedure to review your denial. We call this the appeal process.
As a SCAN member you may file the appeal yourself or appoint someone to do it for you. This person you appoint would be your authorized representative. You can appoint a relative, friend, advocate, doctor, attorney, or other person to act for you. If you already have someone authorized under state law to act for you, this person can file the appeal on your behalf. You can download the CMS Appointment of Representation form (Form CMS-1696) from the CMS website.
To start an appeal you, your doctor, or your representative, must contact us. If your health requires a quick response, you must ask for a “fast appeal.”
If you are asking for a standard appeal, you must make your appeal in writing by submitting a signed request.
If you are asking for a “fast appeal”, you may make your appeal in writing or by calling SCAN Member Services Department at the number listed above. To make a written appeal, you may send your request via FAX to: 562-989-0958 or by mail to:
SCAN Health PlanAttention: Grievance and Appeals Department
PO Box 22644
Long Beach, CA 90801-5644
You must make your appeal request within 60 calendar days from the date on the written notice we sent to tell you our answer to your request for a coverage decision. If you miss this deadline and have a good reason for missing it, we may give you more time to make your appeal.
We must address your appeal as quickly as your case requires based on your health status, but no later than 30 days after receiving your request. When you request a “fast appeal”, we must give you our answer within 72 hours, only if meets the Medicare criteria for a “fast appeal”. We may extend the time frame for an appeal by up to 14 days if you ask for the extension, or if we justify a need for additional information and the delay is in your best interest. If we deny your appeal in whole or in part, our written decision will explain why we denied it, and will tell you about any dispute resolution options you may have.
Should you have appeal process or status questions, please contact SCAN Member Services Department at the number listed above.
For more detailed information on the appeal process please refer to your Evidence of Coverage.