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 Proces
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.
Oklahoma Health Care Authority
Grievance Docket Clerk Legal Division
P.O. Drawer 18497
Oklahoma City, OK 73154-0497
Fax Number: 405-530-3444
Phone Number: 405-522-7217 or 405-522-7587
Medicare eligible participants have a right to file an appeal at:
For appeals contact your PACE Program who will contact MAXIMUS for you.
Appointing a Representative
As a Cherokee Elder Care Participant, you can ask someone to act on your behalf. If you want to, you can name another person to act for you as your “representative” to make your coverage decisions for you or to make an appeal. ask for the “Appointment of Representative” form, or download by clicking on the links provided below. The form gives that person permission to act on your behalf. It must be signed by you and by the person who you would like to act on your behalf. You must give us a copy of the signed form. There may be someone who is already legally authorized to act as your representative under State law.
CMS form 1696
CMS form 1696- Spanish