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HOW TO INITIATE AN APPEAL that is not about a claim
You may request an appeal when:
- The requested services do not meet the requirements of the enrollee’s health plan.
- The services are excluded from the plan.
- Care is denied because the services being requested do not meet Corphealth’s behavioral health criteria.
Who may request an appeal?
If you have received a denial letter, the following individuals may submit an appeal:
Any enrollee or his/her authorized representative
Any health care provider
The enrollee's attorney or a legislative or regulatory agency, such as an Insurance Commissioner or Department of Labor
Appeal Process
The appeal should be submitted as soon as possible after a treatment service
has been denied.
The appeal may be requested by phone or in writing to Corphealth, unless otherwise indicated. Follow the appeal instructions. The instructions are attached to your denial letter.*
Corphealth, Inc.
Grievance and Appeals
1300 Summit Ave., Ste. 660
Fort Worth, TX 76102
Telephone (800) 777-6330 ext 4440
Fax (817) 335-9100
*Humana members- Humana appeals are not processed by Corphealth. Please refer to the phone number on the back of your insurance card. You may call the number for further appeal instructions.
Expedited Appeal
An expedited appeal is a request to change a denial of services for urgent care. Urgent care is any request for behavioral treatment, if you feel that without services the patient’s health and safety would be in danger. An urgent care condition has the potential to become an emergency in the absence of treatment.
The expedited appeal must be requested at the time of the denial. The patient must still be in treatment at the same level of care. The appeal request may be submitted by mail, telephone, or fax to the Corphealth grievance and appeal department at the address, phone or fax numbers listed above. A determination will be made within 72 hours unless a shorter timeframe is required by the state.
Standard Appeal
If the appeal request is not considered expedited, it will be handled as a standard appeal. A standard appeal may be requested orally or in writing via mail, telephone, or fax to the Corphealth grievance and appeal department at the address, phone or fax numbers listed above.
Right to an Independent Review (IRO)
If you do not agree with the outcome of the appeal determination, you may be eligible to request a review by an Independent Review Organization (IRO). An IRO is not connected in any way with Corphealth. The instructions, process, and availability of IRO vary by state and benefit plan. Not all plans have a right to an IRO. Please refer to the denial letter for information on obtaining an IRO.
Right to Bring a Civil Action
If your plan is governed by the Employee Retirement Income Security Act (ERISA), you have the right to file a civil action under section 502 (a) of ERISA if your claim has not been approved after all reviews have been completed.
Claims Appeal
Corphealth offers you the right to
appeal any claims decision. Claims Appeals should be
made no later than sixty days from the date you receive
your claim decision. A request for appeal can be made
verbally by calling 1-800 777-6330, through email at claimscs@corphealth.com,
or by sending a written request attached to any mitigating
information to support your appeal of the original claims
determination to:
Corphealth
1300 Summit Avenue, Suite 811
Fort Worth, TX, 76102-4420
Attn: Claims Appea
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