State Fair Hearing Policies and Processes

If you do not agree with Alliance Health’s decision on your appeal, you can ask for a State Fair Hearing. In North Carolina, State Fair Hearings include an offer of a free and voluntary mediation session. This meeting is held before your State Fair Hearing date.

When you ask for a State Fair Hearing, you will get a phone call from the Mediation Network of North Carolina. The Mediation Network will call you within 5 business days after you request a State Fair Hearing. During this call you will be offered a mediation meeting. The state offers this free meeting to help resolve your disagreement quickly. These meetings are held by phone.

You do not have to accept this meeting. You can ask to schedule just your State Fair Hearing. If you do accept, a Mediation Network counselor will lead your meeting. This person does not take sides. A member of Alliance Health’s review team will also attend. If the meeting does not help with your disagreement you will have a State Fair Hearing.

State Fair Hearings are held by the NC Office of Administrative Hearings (OAH). An administrative law judge will review your request along with any new information you may have. The judge will make a decision on your service request. You can give any updates and facts you need to at this hearing. A member of Alliance Health’s review team will attend. You may ask questions about Alliance Health’s decision. The judge in your State Fair Hearing is not a part of Alliance Health in any way.

It is easy to ask for a State Fair Hearing. Use one of the options below:

• Mail: Fill out, sign and mail the State Fair Hearing Request Form that comes with your notice. You will find the addresses listed on the form.
• Fax: Fill out, sign and fax the State Fair Hearing Request Form that comes with your notice. You will find the fax numbers you need listed on the form.
• Phone: Call OAH at 1-984-236-1860 and ask for a State Fair Hearing. You will get help with your request during this call.

If you are unhappy with your State Fair Hearing decision, you can appeal to the North Carolina Superior Court in the county where you live. You have 30 days from the day you get your decision from your State Fair Hearing to appeal to the Superior Court.

You have a right to ask for a State Fair Hearing if you disagree with a disenrollment decision. You will have a chance to give more information and ask questions about the decision for you to make a change before an administrative law judge. The judge in your State Fair Hearing is not a part of Alliance Health in any way. In North Carolina, State Fair Hearings include an offer of a free and voluntary mediation session that is held before your hearing date.

If you disagree with a disenrollment decision, you have 30 days from the date on the letter telling you of the decision to ask for a State Fair Hearing. You can ask for a State Fair Hearing yourself. You may also ask a friend, family member, your provider or a lawyer to help you.

You can use one of the following ways to request a State Fair Hearing:

• Mail: Fill out, sign and mail the State Fair Hearing Request Form that comes with your notice. You will find the address listed on the form.
• Fax: Fill out, sign and fax the State Fair Hearing Request Form that comes with your notice. You will find the fax number listed on the form.
• Phone: Call OAH at 1-984-236-1860 and ask for a State Fair Hearing. You will get help with your request during this call. When you ask for a State Fair Hearing, you and any person you have chosen to help you can see the records and criteria used to make the decision. If you choose to have someone help you, you must give them permission. Include their name and contact information on the State Fair Hearing Request Form.

If you are unhappy with your State Fair Hearing decision, you can appeal to the North Carolina Superior Court in the county where you live. You have 30 days from the day you get your decision from your State Fair Hearing final decision to appeal to the Superior Court.