Know Your Member Rights
Read chapter 8 of your plan’s Evidence of Coverage to understand your member rights and responsibilities.
How do I...
- 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?
- 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?
- What Is a Grievance?
- Who Can File a Grievance?
- Why File a Grievance?
- Can I Expedite a Grievance?
- Where can a Grievance Be Filed?
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.
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.