Sometimes Alliance Health may deny, suspend, reduce or terminate a request your provider makes for you for state-funded services offered by our plan. If that happens, you will receive a letter from Alliance Health notifying you of any decision to deny, suspend, reduce or terminate a service request your provider makes. All policies and procedures related to appeals for UM decisions are in adherence with 10A NCAC 27G .7004. The letter will include information regarding the reason for the decision and any available options while the appeal is under review. State-funded services recipients have the right to appeal decisions to deny, suspend, reduce or terminate their services. Alliance Health must receive the appeal in writing within 15 working days from the date of the letter.
When you ask for an appeal with the Health Plan, Alliance Health has 7 business days to give you an answer. You can ask a family member, a friend, your provider or a legal representative to help you with your appeal. You or your legal guardian can ask for an appeal. You can call Alliance Health at 919-651-8545 or email [email protected] if you need help with your appeal request. It’s easy to ask for an appeal by using one of the options below:
- MAIL: Fill out and sign the appeal request in the notice you receive about our decision. Mail it to the address listed on the form. We must receive your form no later than 15 working days after the date on the notification letter.
- FAX: Fill out, sign, and fax the Appeal Request Form in the notice you receive about our decision. You will find the fax number listed on the form. We must receive your form no later than 15 working days after the date on the notification letter.
- EMAIL: Fill out, sign, and email the Appeal Request Form in the notice you receive about our decision. You will find the email listed on the form. We must receive your form no later than 15 business days after the date on the notice. To appeal the reduction, suspension, termination or denial of non-Medicaid benefits, you must complete and return the Non-Medicaid Services Appeal Form (included in the notice of decision mailed to you) to any of the following within 15 working days of the date of the notification letter.
- WEBSITE: Appeals can also be submitted through the web portal.