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
ERISA Affidavit – Maternity Coverage
Last Updated: November 21, 2021 | Letter Type: Affidavits | Jurisdiction: ERISA
AFFIDAVIT OF COMPLIANCE Maternity Services Incorporated by Reference in 28 US Code § 1746 Patient/Multiple Patients: DOS: I hereby certify that I have collected, verified, and am maintaining on file evidence that the below Employer/Third-Party Administrator or Contracted Entity has met the provisions of 29 CFR § 2590.711(a)(1-2), which states: (a)... View more
ERISA Affidavit – Medical Necessity – Qualified Reviewers
Last Updated: November 21, 2021 | Letter Type: Affidavits | Jurisdiction: ERISA
AFFIDAVIT OF COMPLIANCE Medical Necessity Incorporated by Reference in 28 US Code § 1746 Patient/Multiple Patients: DOS: I hereby certify that I have collected, verified, and am maintaining on file evidence that the below Employer/Third-Party Administrator or Contracted Entity has met the provisions of 29 CFR §2560.503-1 (h)(3) which states: (3)... View more
ERISA Affidavit – No Authorization for ER Services and Care
Last Updated: November 20, 2021 | Letter Type: Affidavits | Jurisdiction: ERISA
AFFIDAVIT OF COMPLIANCE Emergency and Urgently Needed Services Incorporated by Reference in 28 US Code § 1746 Patient/Multiple Patients: DOS: I hereby certify that I have collected, verified, and am maintaining on file evidence that the below Employer/Third-Party Administrator or Contracted Entity has met the provisions of 29 CFR §2590.715-2719(A)(b), which... View more
ERISA Affidavit – Non-urgent Authorization Timeframes
Last Updated: November 21, 2021 | Letter Type: Affidavits | Jurisdiction: ERISA
AFFIDAVIT OF COMPLIANCE Timeframes for Authorization Requests – Non-Urgent Health Services Incorporated by Reference in 28 US Code § 1746 Patient/Multiple Patients: DOS: I hereby certify that I have collected, verified, and am maintaining on file evidence that the below Employer/Third-Party Administrator or Contracted Entity has met the provisions of 29... View more
ERISA Affidavit – Notice Requirements for Adverse Determinations
Last Updated: November 20, 2021 | Letter Type: Affidavits | Jurisdiction: ERISA
AFFIDAVIT OF COMPLIANCE Notice Requirements for Adverse Determinations Incorporated by Reference in 28 US Code § 1746 Patient/Multiple Patients: DOS: I hereby certify that I have collected, verified, and am maintaining on file evidence that the below Employer/Third-Party Administrator or Contracted Entity has met the provisions of 29 CFR §2560.503-1 (g)(1),... View more
ERISA Appeal – Maternity Coverage
Last Updated: April 29, 2020 | Letter Type: Appeals | Jurisdiction: ERISA
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Department of Labor (DOL) for ’s failure to provide coverage for maternity services and care as required by Federal law. Our investigation has concluded the following: Under existing Federal Law no prior authorization is required pursuant to... View more
ERISA Appeal – Medical Necessity – Qualified Reviewers
Last Updated: November 21, 2021 | Letter Type: Appeals | Jurisdiction: ERISA
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Department of Labor (DOL) for ’s failure to reimburse medically necessary services as required by Federal law. Our investigation has concluded the following: Please be advised that 29 CFR §2560.503-1 (g)(1) states the plan must establish and... View more
ERISA Appeal – No Authorization for ER Services and Care
Last Updated: November 20, 2021 | Letter Type: Appeals | Jurisdiction: ERISA
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Department of Labor (DOL) for ’s failure to reimburse emergency services as required by Federal law. Our investigation has concluded the following: As you are aware, a health plan is financially responsible for emergency and urgently needed... View more
ERISA Appeal – Non-urgent Authorization Timeframes
Last Updated: November 21, 2021 | Letter Type: Appeals | Jurisdiction: ERISA
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Department of Labor (DOL) for ’s failure to meet the timeframe and notice requirements for non-urgent authorization requests as required by Federal law. Our investigation has concluded the following: THIS REQUEST IS NOW DAYS IN VIOLATION OF... View more