Appeals Process

Group Health has a formal internal appeals process for review of member coverage and claims disputes. Disputes are reviewed through a first-level appeal process, with an optional second-level review available. Unless your contract states otherwise, you will be able to use Group Health's first-level and optional second-level processes.

Appeals that are not resolved to your satisfaction may be eligible for independent review by a state-certified independent review organization. Group Health pays for the review and must abide by the independent review organization's decision. Medicare and federal plan members follow the independent review process administered by the Medicare and federal programs.

Expedited Reviews

You or your physician can ask for a fast review. When a delay would seriously threaten your health, reviews can be expedited and a determination usually issued within 72 hours.

If you want to initiate an appeal or learn more about your appeal rights, please call toll-free 1-866-458-5479.