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. When 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
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.
State Fair Hearings and Disenrollment Decisions
If you disagree about a decision to change your health plan, you can ask for a State Fair Hearing. The process to ask for a State Fair Hearing for disenrollment decisions is different than the process to ask for a State Fair Hearing when Alliance Health limits or denies a service that you requested. For more information about requesting a State Fair Hearing for disenrollment, see your member handbook.
