Appeals Processes

You have the right to request an appeal

HealthSpan has defined procedures for you to appeal denials issued as a result of our review process, whether it be due to the absence of a benefit, benefit limitations or exhaustions, or medical appropriateness. All requests for services that are denied based on medical appropriateness are determined by a board certified physician. The notice of denial will inform you of the reason for the denial and your rights to an appeal.

If you disagree with the decision, you may appeal the denial through the Appeals Unit. HealthSpan’s internal appeals process includes one level of appeal. If HealthSpan continues to deny your request, you may request a review from an external source at no cost to you. The appeal denial notice will provide you with information that you will need to initiate an external review. The appeals coordinator will facilitate the external review process by arranging the evaluation, forwarding pertinent information, and communicating with you.

Expedited appeals

Expedited appeal processes may be eligible for concurrent internal and external appeal processes. For more information, please contact the Appeals Unit at 216-635-4664 or 888-479-5333.

Filing an appeal

To assist you with filing an appeal or grievance, please feel free to complete this form and fax or mail to:

HealthSpan Appeals Unit
PO Box 93764
Cleveland, Ohio 44101-5764
Fax #: 1-216-635-4673

Note: This form is not required; however, all appeal/grievance requests must include the appropriate signatures.

If you are on Medicare

If you are a Medicare beneficiary who received a denial for services other than Part D prescription drug benefits, the Appeals Unit will automatically forward the denial to the Medicare’s Independent Review Entity. If you are a Medicare beneficiary who received a denial of a Part D prescription drug benefit, we will provide you with information that you will need to initiate the external review. At each step of the way, you will be guided and directed to ensure you understand the appeals process. Click here  for more information on the Appeals process for Medicare members.