2024 Evidence of Coverage for UnitedHealthcare® Group Medicare Advantage PEBB Balance (PPO) Chapter 9: What to do if you have a problem or complaint (coverage decisions, appeals, complaints) 203 A “fast appeal” is also called an “expedited reconsideration.” Step 1: Decide if you need a “standard appeal” or a “fast appeal.” A standard appeal is usually made within 30 days or 7 days for Part B drugs. A fast appeal is generally made within 72 hours. · If you are appealing a decision we made about coverage for care that you have not yet received, you and/or your doctor will need to decide if you need a “fast appeal.” If your doctor tells us that your health requires a “fast appeal,” we will give you a fast appeal. · The requirements for getting a “fast appeal” are the same as those for getting a “fast coverage decision” in Section 5.2 of this chapter. Step 2: Ask our plan for an appeal or a fast appeal · If you are asking for a standard appeal, submit your standard appeal in writing. Chapter 2 has contact information. · If you are asking for a fast appeal, make your appeal in writing or call us. Chapter 2 has contact information. · You must make your appeal request within 60 calendar days from the date on the written notice we sent to tell you our answer on the coverage decision. If you miss this deadline and have a good reason for missing it, explain the reason your appeal is late when you make your appeal. We may give you more time to make your appeal. Examples of good cause may include a serious illness that prevented you from contacting us or if we provided you with incorrect or incomplete information about the deadline for requesting an appeal. · You can ask for a copy of the information regarding your medical decision. You and your doctor may add more information to support your appeal. Step 3: We consider your appeal and we give you our answer. · When our plan is reviewing your appeal, we take a careful look at all of the information. We check to see if we were following all the rules when we said no to your request. · We will gather more information if needed, possibly contacting you or your doctor.