If You Disagree With an Appeal Decisionġ-888-4LA-CARE ( 1-88) Provider Informationġ-866-LACARE6 ( 1-86) Medi-Cal Member Servicesġ-88 (TTY 711) 24 hours a day L.A.We will make a decision within 72 hours of receiving your appeal. To ask for an expedited review, call Member Services at 1-88 (TTY: 711). If you or your doctor wants us to make a fast decision because the time it takes to decide your appeal would put your life, health or ability to function in danger, you can ask for an expedited (fast) review.

In this case, the State Hearing has final say. But if you ask for a State Hearing first, and the hearing has already happened, you cannot ask for an IMR. If we do not provide you with our appeal decision within 30 days, you can request a State Hearing and an IMR with the DMHC. Within 30 days, we will tell you our appeal decision and send you a Notice of Appeal Resolution (NAR) letter. Care will send you a letter telling you we got it. Within 5 days of getting your appeal, L.A. If you need help asking for an appeal or with Aid Paid Pending, we can help you. Your doctor’s office will have appeal forms available. Be sure to include your name, health plan ID number and the service you are appealing. Care Member Services at 1-88 (TTY: 711) and ask to have a form sent to you. Give your name, health plan ID number and the service you are appealing.Ĭall L.A. Care Member Services at 1-88 (TTY: 711) 24 hours a day 7 days a week including holidays.

You can file an appeal by phone, in writing or online:Ĭall L.A. When you request an appeal under these circumstances, the service(s) will continue. To receive Aid Paid Pending, you must ask us for an appeal within 10 days from the date on the NOA or before the date we said your service(s) will stop, whichever is later. If we decided to reduce, suspend, or stop a service(s) you are getting now, you can continue getting that service(s) while you wait for your appeal to be decided. You must ask for an appeal within 60 days from the date on the NOA you got from us. Your PCP or other provider can also ask us for an appeal for you with your written permission.

If we sent you a Notice of Action (NOA) letter telling you that we are denying, delaying, changing or ending a service(s), and you do not agree with our decision, you can ask us for an appeal. An appeal is a request for us to review and change a decision we made about your service(s).

Aetna timely filing for appeals