12/16/2023 0 Comments Uhc timely filing limit 2020![]() You may file a grievance within sixty (60) calendar days of the date of the circumstance giving rise to the grievance. For example, you would file a grievance: if you have a problem with things such as the quality of your care during a hospital stay you feel you are being encouraged to leave your plan waiting times on the phone, at a network pharmacy, in the waiting room, or in the exam room waiting too long for prescriptions to be filled the way your doctors, network pharmacists or others behave not being able to reach someone by phone or obtain the information you need or lack of cleanliness or the condition of the doctor's office. If your health plan or your Primary Care Provider decides, based on medical criteria, that your situation is Time-Sensitive or if any physician calls or writes in support of your request for an expedited review, your Medicare Advantage health plan will issue a decision as expeditiously as possible, but no later than seventy-two (72) hours plus 14 calendar days, if an extension is taken, after receiving the request.Ī grievance may be filed by any of the following:Ī grievance is a type of complaint you make if you have a complaint or problem that does not involve payment or services by your health plan or a Contracting Medical Provider. A Time-Sensitive situation is a situation where waiting for a decision to be made within the timeframe of the standard decision-making process could seriously jeopardize: You have the right to request and receive expedited decisions affecting your medical treatment in "Time-Sensitive" situations. You may use the appeal procedure when you want a reconsideration of a decision (coverage determination) that was made regarding a service or the amount of payment your health plan paid for a service. ![]() You may fax your written request toll-free to 1-87. ![]() UnitedHealthcare Appeals and Grievances Department Part D UnitedHealthcare Complaint and Appeals Department Include in your written request the reason why you could not file within the sixty (60) day timeframe.Īn appeal may be filed in writing directly to us. Note: The sixty (60) day limit may be extended for good cause.
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