Know Your Member Rights | ProCare Advantage
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Know Your Member Rights

How do I...

File an appeal
  • What Is an Appeal?
  • Who Can File an Appeal?
  • When Can an Appeal Be Filed?
  • Can I Expedite an Appeal?
  • Where Can an Appeal Be Filed?
  • What Happens Next?
Request an organization determination
  • What is an Organization Determination?
  • Who Can Request an Organization Determination?
  • When Can an Organization Determination Be Requested?
  • Where Can an Organization Determination be filed?
  • What Is a Standard Reconsideration (i.e., Appeal)?
  • How to Request a Reconsideration
  • Important Things to Know About Asking for Standard Reconsideration
  • Where Can a Reconsideration Be Filed?
  • What is a Good Cause Exception?
File a grievance
  • What Is a Grievance?
  • Who Can File a Grievance?
  • Why File a Grievance?
  • Can I Expedite a Grievance?
  • Where can a Grievance Be Filed?
Obtain an aggregate number of appeals, grievances or exceptions

You have the right to request the number of appeals and the number of quality of care grievances received by ProCare Medicare Advantage (HMO I-SNP) during a plan year.

Appoint a representative to file a grievance or complaint

You or someone you name may file a complaint (grievance) or appeal for you. The person you name would be your “appointed representative”. You may name a relative, friend, lawyer, advocate, health care provider, or anyone else to act on your behalf.

Request a coverage determination
  • What Is a Coverage Determination?
  • What Is an Exception?
  • When Can a Coverage Determination/ Exception Be Requested?
  • Important Things to Know About Asking for Exceptions
  • Where Can a Coverage Determination/Exception Be Filed?

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