If you are dissatisfied with the decision made on your services, you may file an appeal within sixty (60) days following the receipt of a denial letter. The appeal can be written or verbal. If you need help with filing an appeal, call our Customer Care Center.
You, as the enrollee, may file an appeal. An enrollee representative, a legal representative of a deceased enrollee's estate, or a provider acting on behalf of an enrollee, and with the enrollee's written consent, may file an appeal.
You can file an appeal by calling B – UFC/ACC's Customer Care Center. We will assist you in filing your appeal and we also provide interpretation services in any language at no cost to you.
You can file an appeal in writing and mail it to:
B – UFC/ACC will provide you with a written notice of appeal resolution within (30) days of filing the appeal. We may extend the timeframes up to (14) days, when you ask for an extension or if we establish a need for an extension to get additional information. When this happens, we will notify you in writing.
You may file an expedited appeal, or it may be filed on your behalf by your provider if you need an urgent decision. An expedited appeal will be approved if B – UFC/ACC finds that the time to process a standard appeal would seriously jeopardize your health, life, or ability to attain, maintain or regain maximum function.
If an expedited appeal request is not approved, B – UFC/ACC will notify you within 24 hours and transfer the appeal to the 30-day timeframe for a standard appeal. If we agree to accept your request for an expedited appeal, B – UFC/ACC will make a decision no later than 72 hours following the receipt of the appeal. We may extend the timeframe up to 14 calendar days to obtain additional information. When this happens, we will notify you in writing.
If services were reduced, suspended, or terminated, a request to continue receiving services during the appeal process must be submitted in writing to B – UFC/ ACC within 10 days of the receipt of the Notice of Adverse Benefit Determination letter. If B – UFC/ACC or a State Fair hearing decision upholds the denial, you may be responsible for payment of those services. For further information, call our Customer Care Center.
If you are not satisfied with the appeal decision, you may file a request for State Fair Hearing with B – UFC/ACC. This request must be made in writing within 120 days of the date of receipt of the appeal decision. You can mail or fax your request for a State Fair Hearing to:
Legal Services Programs are available to help you with the hearing process. Click here for general legal information about your rights.