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Found 410 Letters.

CO HMO Appeal – Interest Owed on Late Claims

Last Updated: November 21, 2021 | Letter Type: Appeals | Jurisdiction: CO HMO

URGENT- IMPERATIVE ACTION Dear Director of : This office has been asked to file a formal complaint with the Colorado Division of Insurance for ’s failure to remit automatic interest accrued on this claim as required by state law. Our investigation has concluded the following: Per CO Rev. Stat §10-16-106.5(4)(a),  was required to reimburse this... View more

CO HMO Appeal – Maternity Coverage

Last Updated: November 21, 2021 | Letter Type: Appeals | Jurisdiction: CO HMO

IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Colorado Division of Insurance for ’s failure to provide coverage for maternity services and care as required by state law. Our investigation has concluded the following: As you may know, CO Rev. Stat. §10-16-704(5.5)(b)(I)(A) states: (I) ”Emergency medical... View more

CO HMO Appeal – Medical Necessity – Qualified Reviewers

Last Updated: November 21, 2021 | Letter Type: Appeals | Jurisdiction: CO HMO

IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Colorado Division of Insurance for ’s failure to reimburse medically necessary services as required by state law. Our investigation has concluded the following: Please be advised that our treating physician was a . However, your reviewer was... View more

CO HMO Appeal – No Authorization for ER Services and Care

Last Updated: November 20, 2021 | Letter Type: Appeals | Jurisdiction: CO HMO

IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Colorado Division of Insurance for ’s failure to reimburse emergency services as required by state law. Our investigation has concluded the following: CO Rev. Stat. §10-16-704(5.5)(b)(II)(A-B) defines “emergency services and care” as: (A) A medical screening examination that is... View more

CO HMO Appeal – Non-urgent Authorization Timeframes

Last Updated: November 21, 2021 | Letter Type: Appeals | Jurisdiction: CO HMO

IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Colorado Division of Insurance for ’s failure to meet the timeframe and notice requirements for non-urgent authorization requests as required by state law. Our investigation has concluded the following: THIS REQUEST IS NOW DAYS IN VIOLATION OF... View more

CO HMO Appeal – Notice Requirements for Adverse Determinations

Last Updated: November 20, 2021 | Letter Type: Appeals | Jurisdiction: CO HMO

IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Colorado Division of Insurance for ’s failure to reimburse medically necessary services and meet notice requirements as required by state law. Our investigation has concluded the following: On , denied this claim as not medically necessary. To... View more

CO HMO Appeal – Poststabilization Timeframe

Last Updated: November 20, 2021 | Letter Type: Appeals | Jurisdiction: CO HMO

IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Colorado Division of Insurance for ’s failure to reimburse emergency and/or statutorily granted post-stabilization services and care as required by state law. Our investigation has concluded the following: TO DATE, HAS FAILED TO REIMBURSE EMERGENCY AND STATUTORILY... View more

CO HMO Appeal – Refund Recoupment

Last Updated: November 20, 2021 | Letter Type: Appeals | Jurisdiction: CO HMO

IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Colorado Division of Insurance for ’s failure to properly reimburse medically necessary services as required by state law. Our investigation has concluded the following: Please be advised that must meet the written requirements set forth in CO... View more

CO HMO Appeal – Retroactive Denial for Authorized Care

Last Updated: November 20, 2021 | Letter Type: Appeals | Jurisdiction: CO HMO

IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Colorado Division of Insurance for ’s failure to reimburse authorized health services as required by state law. On , authorization number was issued by . Please be advised CO Rev. Stat. §10-16-704(4) states: (4) When a treatment... View more

CO HMO Appeal – Untimely Payment

Last Updated: May 4, 2021 | Letter Type: Appeals | Jurisdiction: CO HMO

IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Colorado Division of Insurance for ’s failure to remit automatic interest accrued on this claim as required by state law. Our investigation has concluded the following: Per CO Rev. Stat §10-16-106.5(4)(a),  was required to reimburse this claim... View more