OHA: Three Step Complaint Process

Three Step Complaint Process

Managed care health plans and agencies that oversee health plans have formal procedures for you to follow if you have a problem. The following represents the general procedure, but it may vary depending on your particular managed care health plan. {elderly woman}

  • Make sure the service is not excluded in your health plan contract
     
  • Appeal "internally" to your insurer first; Connecticut State law requires your that your appeal is to be reviewed and resolved within sixty (60) days from the date you submit the request for appeal
     
  • Obtain a written denial from your plan’s internal appeals process
     
  • File for an external appeal with the State of Connecticut within 30 days

For more detailed explanations, click on...

Step One                         Step Two                         Step Three

 

 

 

 

 

 

 

Other Related Links:

 

Determine the Problem


How to Write an Appeal Letter

 

Internal Appeals Process

 

External Appeals Process

 

Download Consent Statement



Content Last Modified on 5/30/2007 3:04:01 PM