Sort:

Found 373 Letters.

AL HMO Appeal – Maternity

Letter Type: Affidavits | Jurisdiction: AL HMO | Last Updated: October 6, 2021

IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Alabama Department of Insurance for ’s failure to provide coverage for maternity services and care as required by state law. Our investigation has concluded the following: Under existing Alabama law, has a duty to provide all Maternity-covered... View more

AL HMO Appeal – Medical Necessity – Qualified Reviewer

Letter Type: Affidavits | Jurisdiction: AL HMO | Last Updated: October 6, 2021

IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Alabama Department 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

AL HMO Appeal – Notice Requirements

Letter Type: Affidavits | Jurisdiction: AL HMO | Last Updated: October 6, 2021

IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Alabama Department 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

AL HMO Appeal – Post-Stabilization

Letter Type: Affidavits | Jurisdiction: AL HMO | Last Updated: October 7, 2021

IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Alabama Department 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

AL HMO Appeal – Recoupment

Letter Type: Affidavits | Jurisdiction: AL HMO | Last Updated: October 7, 2021

IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Alabama Department 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 substantiate how it reached its overpayment determination and... View more

AL HMO Appeal – Untimely Payment

Letter Type: Affidavits | Jurisdiction: AL HMO | Last Updated: October 7, 2021

URGENT- IMPERATIVE ACTION Dear Director of : This office has been asked to file a formal complaint with the Alabama Department of Insurance for ’s failure to remit timely payment and automatic interest accrued on this claim as required by state law. Our investigation has concluded the following: was required to reimburse this claim within... View more

CA HMO Affidavit – Auth Timeframe – Non-urgent

Letter Type: Affidavits | Jurisdiction: CA HMO | Last Updated: August 29, 2020

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 Knox-Keene Plan or Contracted Entity has met the provisions of... View more

CA HMO Affidavit – COB Denial

Letter Type: Affidavits | Jurisdiction: CA HMO | Last Updated: August 29, 2020

AFFIDAVIT OF COMPLIANCE Coordination of Benefits 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 Knox-Keene Plan or Contracted Entity has met the provisions of 28 CCR §1300.71(h)(3) and 28 CCR... View more

CA HMO Affidavit – Concurrent Disagreement of Care

Letter Type: Affidavits | Jurisdiction: CA HMO | Last Updated: August 29, 2020

AFFIDAVIT OF COMPLIANCE Disagreement of Post-Stabilization Care 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 Knox-Keene Plan or Contracted Entity has met the provisions of Health & Safety Code §1371.4(d)... View more

CA HMO Affidavit – Denial of Timely Billed Claims

Letter Type: Affidavits | Jurisdiction: CA HMO | Last Updated: September 5, 2020

AFFIDAVIT OF COMPLIANCE Denial of Timely Billed Claims 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 Knox-Keene Plan or Contracted Entity has met the provisions of 28 CCR §1300.71(b)(1) and... View more