Transcription of Appealing a coverage decision made by your …
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Copyright 2009 Pennsylvania Health Law Project A Guide to Grievances, Complaints, and Fair Hearings in Pennsylvania s medical assistance Program. Prepared by: The Pennsylvania Health Law Project 1-800-274-3258 1-866-236-3610 TTY Appealing a coverage decision made by your medical assistance plan Consumers who have had health care services denied, reduced, or stopped by their medical assistance (MA) heath plan should appeal if they disagree with those deci-sions. This brochure explains the appeals processes available to medical assistance con-sumers. The appeal process available to a consumer depends on whether the individual receives MA through a Managed Care Organization (MCO) or through the Fee for Ser-vice (FFS) system. Individuals receiving MA through the FFS system (ACCESS Card) who have been denied medical care or services can appeal the decision by asking for a Department of Public Welfare (DPW) Fair Hearing.
Consumers who have had health care services denied, reduced, or stopped by their Medical Assistance (MA) heath plan should appeal if they disagree with those deci-
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