If Cherokee Elder Care refuses to provide or pay for a service that you feel is necessary for your health, you or your representative have the right to request an appeal of Cherokee Elder Care’ decision.
You may request an appeal if Cherokee Elder Care:
- Denies a Service: refuses to provide a service you have requested
- Reduces a Service: reduces a previously approved service you are presently receiving
- Denies Payment for a Service: refuses to pay for a service you have already received
- Does Not Act Promptly: fails to respond in the required time to a request for services or payment
- Disenrolls you on an involuntary basis
- Refuses to enroll you in the program
INTERNAL AND EXTERNAL APPEALS PROCESS
There are two types of appeals’ systems available to you:
- Cherokee Elder Care’ Internal Appeal Process
- External Medicare or Medicaid Appeals Process
How To File An Appeal
You can file an appeal if Cherokee Elder Care refuses to provide or pay for services you feel are necessary for your health. If your Personal Care Team denies a request for services or payment or reduces your services, your team will provide you written information about the denial and about how to file an appeal.
If Cherokee Elder Care agrees to provide the service you requested, we must authorize or provide the service as quickly as your health requires.
Medicaid eligible participants have a right to appeal to the State of Oklahoma at the same time you have filed an appeal with Cherokee Elder Care.