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Application for the State of Indiana Children’s Health Insurance Program Amendment #7
Effective Date:
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Approval Date:
If you wish to appeal, send a signed letter to your local Division of Family Resources office at the address at the top of this Notice. If you prefer, you can send your appeal to the Indiana Family and Social Services Administration, Division of Family Resources, Hearings and Appeals, room W392, Indianapolis IN 46204. If you have questions, please contact your caseworker.
You will be notified in writing of the date, time and place for the hearing. You can represent yourself, or have someone represent you such as attorney, friend, or relative. If your wish to have legal representation and cannot afford it, you may call the Legal Services Organization serving your area at (800) 869-0212.‖
FSSA requires an expedited review process for medical services when requested by the enrolled member in certain situations. Each MCO is contractually required to "make available an expedited informal and formal grievance procedure for member grievances that cannot be delayed without risking permanent damage to the member's health," and the expedited review must be completed within 72 hours. Members are notified by their MCO. Each MCO has a member handbook that gives guidance on this issue. For example, the MDwise MCO member handbook states: "In an emergency, grievances will be handled quickly. This is called an "expedited" grievance or appeal. If your case can be expedited, we will review your case and notify you of a decision within 72 hours. Call us at (317) 630-2831 or 1-800-356-1204 to see if this can be done." The review process is in compliance with Indiana’s health insurance law, I.C. 27-13-10.
Premium Assistance Programs
12.3 If providing coverage through a group health plan that does not meet the requirements of enrollees have the option to obtain health benefits coverage other than through the group health plan at initial enrollment and at each redetermination of eligibility.