State Fair Hearings
If you've finished the appeals process and you’re not happy with the outcome, you may request a state fair hearing.
You must request your state fair hearing within 90 days of getting notice of the appeal decision.
How do you request a state fair hearing?
You may request a state fair hearing with the Iowa Department of Human Services in person, by phone or in writing. To file a request in writing, do one of the following:
- Complete a state fair hearing request electronically, or
- Write a letter telling us why you think AmeriHealth Caritas Iowa’s decision is wrong.
Call the Department of Human Services Appeals Section at (515)281-3094 if you want to appeal by phone.
Or mail, fax or take your appeal to:
Department of Human Services
1305 E. Walnut St., 5th Floor
Des Moines, IA 50319
Continuing benefits during an appeal and/or state fair hearing
You can keep getting covered services while you wait for us to decide on an appeal or while a state fair hearing is pending if all of the following apply:
- The appeal is filed on or before the later of:
- 10 days from the date we mailed the notice of action.
- Before the effective date on the notice of action.
- The appeal is related to:
- Reduced or suspended services.
- Services that were previously authorized for you.
- The services were ordered by an authorized provider.
- The authorization period for the services has not ended.
- You asked that the services continue.
If AmeriHealth Caritas Iowa continues your benefits while deciding an appeal or while a state fair hearing is pending, the services must be continued until one of the following happens:
- You decide not to continue the appeal.
- You do not request a state fair hearing within 10 days from the date we mail the notice of action.
- The authorization for services expires or authorization service limits are met.
- A hearing decision is issued in the state fair hearing that is adverse to the member.
If the state fair hearing officer agrees with you, we will pay for the services you got while you waited for the decision. However, if the state supports the original appeal decision and rules against you, you will have to pay for the service you received during the waiting period.