Family Hayride

Idaho Appeals

An appeal is a request you may file when you disagree with an adverse benefit determination including a rescission, whether pre- or post-service. You may appeal the decision within 180 days from receipt of the adverse benefit determination. More information on formal appeals including timing and how to file an urgent appeal can be found in your policy document, Section 10 – Complaints, Grievances, and Appeals, which can be found on our website at:

https://www.mountainhealth.coop/individual-plan-docs

To determine if your request qualifies as an urgent treatment request, please review Section 10 – Complaints, Grievances, and Appeals of your policy document at:

https://www.mountainhealth.coop/individual-plan-docs

If you think Mountain Health Co-op (MHC) has made a wrong decision on a service, supply, or drug you have received, you can contact us in writing or by phone at:

University of Utah Health Plans

Appeals Committee Chairperson, Attn: MHC, 6053 Fashion Square Dr.,

Suite 110, Murray, UT 84107

Telephone: 1-844-262-1560

 

Or you may file a formal request for an appeal here:

https://app.healthcare.utah.edu/uhealthPlans/forms/montanaHealth_appeal

 

For more information on appeals see Section 10 – Complaints, Grievances and Appeals of your policy document at: https://www.mountainhealth.coop/individual-plan-docs

Appeals

A complaint does not involve coverage or payment disputes. It includes complaints you may have about MHC, our network providers or pharmacies, and your quality of care. You can file a complaint in writing or by phone at:

University of Utah Health Plans

Appeals Committee Chairperson, Attn: MHC, 6053 Fashion Square Dr.,

Suite 110, Murray, UT 84107

Telephone: 1-844-262-1560

 

Or you may also file a grievance online at:

https://app.healthcare.utah.edu/uhealthPlans/forms/montanaHealth_complaint

For more information on complaints see Section 10 – Complaints, Grievances and Appeals of your policy document at: https://www.mountainhealth.coop/individual-plan-docs

Grievance (see appeal)

Complaint

Idaho consumers have the right to an independent external review of a health claim denial. In most cases, before filing an external review, you must first exhaust your internal grievance and appeal rights. Exceptions are made if the Co-op fails to respond, in writing, to a standard appeal within 35 days, or fails to provide a written response to an urgent appeal within three (3) business days of the date the appeal was filed. We may also agree to waive the exhaustion requirement for an external review request under certain circumstances. You may file an expedited external review with the Idaho Department of Insurance at the time if your request qualifies as an “urgent treatment request”.

You may submit a written request for an external review to:

Idaho Department of Insurance

ATTN: External Review

700 W State St. 3rd Floor

Boise, ID 83720-0043

 

For more information and for an external review request form:

• See the Idaho Department of Insurance web site, www.doi.idaho.gov, or

• Call the Department of Insurance at (208) 334-4250, or toll-free in Idaho at 1-800-721-3272

 

For more information on external reviews see Section 10 – Complaints, Grievances and Appeals of your policy document at: https://www.mountainhealth.coop/individual-plan-docs

External Review for Health Claim Denials

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Mountain Health CO-OP does not discriminate based on race, color, national origin, disability, age, sex, gender, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations.

 

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