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Appeals

What is an appeal?

An appeal is when you ask for AmeriHealth Caritas Iowa to review an action we took. You may file an appeal if you are not satisfied with:

  • A denial of services that your doctor requested.
  • A reduction or limitation of health care services.
  • A suspension of or end to a health care service.

We will send you a written notice of action if your health care services are:

  • Denied.
  • Reduced.
  • Limited.
  • Suspended.

How to file an appeal

You must file your appeal within 30 days after the date on the notice of action.  If you get a notice of action and do not agree with our decisions, you may file an appeal. You can file the appeal by telephone or in writing.

  • By phone: call Member Services at 1-855-332-2440 (TTY: 1-844-214-2471). You can call 24 hours a day, 7 days a week.
    • If you file your appeal by telephone, you will also need to send a letter afterward.
  • In writing: You or your authorized representative can send the letter to:

AmeriHealth Caritas
P.O. Box 7128
London, KY 40742
ATTN: Member Appeals

We will start to review your appeal the day we get it. We will make a decision within 30 calendar days. This can change if we need more information. We may extend the time up to 14 calendar days. If you didn’t ask for the extension, we will send you a letter to explain the delay.

Your doctor can appeal for you. You will need to give your written consent. You may choose someone else to represent you to request an appeal. If the appeal is expedited, you do not need to take this step.

We will send you or your representative a letter with the decision. The letter will tell you how we made our decision.

Expedited appeals

Appeals are expedited when a decision needs to be made in less than 30 days. We will expedite an appeal when your life or health is at risk. Expedited appeals are for health care services. They are not for denied claims.

How to file an expedited appeal

Request an expedited appeal by phone. Call Member Services at 1-855-332-2440 (TTY: 1-844-214-2471). You can call 24 hours a day, 7 days a week.

AmeriHealth Caritas Iowa will start to review your appeal request the day we get it. We will make a decision within 3 business days of getting your request. We will let you know by phone and mail about our decision.

AmeriHealth Caritas Iowa may extend the 72-hour time period by up to 14 calendar days if:

  • You request an extension.
  • If AmeriHealth Caritas Iowa shows a need for additional information and how the delay is in your interest.

If you ask for an expedited appeal and we do not believe it needs a faster decision, it will be reviewed within the standard time frame. We will inform you by phone and writing within 2 calendar days if the time frame for your appeal has changed.

We will let you or your representative know how long you have to submit information for an expedited review.