Filing an Appeal
All appeals for denied services are handled directly through your health plan (Blue Shield, Anthem Blue Cross, etc...). A provider or patient may file an appeal. An expedited appeal would be requested if it is determined that a delay in the decision making process might pose an imminent and serious threat to the patient's health. If it were determined by the health plan that an appeal meets this criteria, an expedited review would apply to the case. An appeal may be filed either by telephone, writing and with some health plans, online. Once an appeal is in process, your health plan will notify Key Medical Group and will request a copy of your denial letter and any notes we've received from your physician.
Every health plan follows different guidelines and procedures. For more information please refer to the health plan's Appeals & Grievance process available through their website.
In addition to the process described above, you may also contact the California Department of Managed Health Care (DMHC). The DMHC is responsible for regulating health care plans. The department has a toll free number (800-400-0815) to receive complaints regarding health care plans. If you have a grievance against the health plan, you should first telephone the plan and use the grievance process before contacting DMHC. If you need help with a grievance which had not been satisfactorily resolved, or has remained unresolved for more than 30 days, you may call the DMHC for assistance.
IF YOU HAVE ANY QUESTIONS REGARDING THE AUTHORIZATIONS PROCESS, PLEASE FEEL FREE TO CONTACT THE KEY MEDICAL GROUP AT (559) 735-3892, 8 AM TO 5 PM MONDAY THROUGH FRIDAY.