MEMBER HANDBOOK - Community Care Behavioral Health

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What kinds of things can I request a Fair Hearing for and when
do I have to ask for a Fair Hearing?
If you are unhappy
because...
Community Care decided
to deny a service because
it is not a covered service.
Community Care decided
not to pay a provider for a
service you received AND
the provider can bill you for
the service.
Community Care did not
decide your First Level
Complaint or Grievance
within 30 days of when you
filed it.
Community Care decided
to deny, decrease, or
approve a service different
than the one your provider
requested because it was
not medically necessary.
A Community Care
provider did not give you
a service by the time you
should have received it.
You must ask for the Fair Hearing...
Within 30 days of the date on the letter
from Community Care telling you of
this decision OR within 30 days of the
date on the letter from Community Care
acknowledging or telling you its decision
after you filed a complaint about this issue.
Within 30 days of the date on the letter
from Community Care telling you that
we did not make a decision about your
complaint or grievance within the time
frame we were supposed to follow.
Within 30 days of the date on the letter
from Community Care telling you of
this decision OR within 30 days of the
date on the letter from Community Care
acknowledging or telling you its decision
after you filed a grievance about this issue.
Within 30 days of the date on the letter
from Community Care telling you its
decision after you filed a complaint about
this issue.
Customer Services 1-800-553-7499