You can ask for a standard appeal. Your plan must give you a decision no later than 30 days after it gets your appeal. (Your plan may extend this time by up to 14 days if you request an extension, or if it needs additional information and the extension benefits you.)
You can ask for a fast appeal if you or your doctor believe that your health could be seriously harmed by waiting too long for a decision. Your plan must decide on a fast appeal no later than 72 hours after it gets your appeal. (Your plan may extend this time by up to 14 days if you request an extension, or if your plan needs additional information and the extension benefits you.)
Please download this form to file a formal appeal regarding any aspect of the medical care or service provided to you.
The process for coverage decisions and appeals can be found in Chapter 9 of your evidence of coverage (EOC). This is the process you use for issues such as whether something is covered or not and the way in which something is covered. Please refer to Chapter 9 of your EOC for a full description of the process.
Please download this form to file a formal grievance regarding any aspect of the medical care or service provided to you.
An appointed representative is a person who can act on your behalf to request an exception, appeals or grievance. This person can be a relative, friend, advocate, doctor, or anyone else whom you trust to act on your behalf. The Appointment of Representative form can be found here:
Astiva
Health Appointment of Representative
(AoR) Form
You may request grievance data orally or in writing by contacting the Member Services Department.
For questions regarding the appeal or grievance process, please see the contact information below.
CALL US
1-866-688-9021, TTY:711
Monday – Friday
8:00 AM – 8:00 PM (PST)
WRITE TO US
Astiva Health - Appeals and Grievances
765 The City Drive South, #200
Orange, CA 92868
You can ask for a standard appeal. Your plan must give you a decision no later than 30 days after it gets your appeal. (Your plan may extend this time by up to 14 days if you request an extension, or if it needs additional information and the extension benefits you.)
You can ask for a fast appeal if you or your doctor believe that your health could be seriously harmed by waiting too long for a decision. Your plan must decide on a fast appeal no later than 72 hours after it gets your appeal. (Your plan may extend this time by up to 14 days if you request an extension, or if your plan needs additional information and the extension benefits you.)
Please download this form to file a formal appeal regarding any aspect of the medical care or service provided to you.
The process for coverage decisions and appeals can be found in Chapter 9 of your evidence of coverage (EOC). This is the process you use for issues such as whether something is covered or not and the way in which something is covered. Please refer to Chapter 9 of your EOC for a full description of the process.
Please download this form to file a formal grievance regarding any aspect of the medical care or service provided to you.
An appointed representative is a person who can act on your behalf to request an exception, appeals or grievance. This person can be a relative, friend, advocate, doctor, or anyone else whom you trust to act on your behalf. The Appointment of Representative form can be found here:
Astiva
Health Appointment of Representative
(AoR) Form
You may request grievance data orally or in writing by contacting the Member Services Department.
For questions regarding the appeal or grievance process, please see the contact information below.
CALL US
1-866-688-9021, TTY:711
Monday – Friday
8:00 AM – 8:00 PM (PST)
WRITE TO US
Astiva Health - Appeals and Grievances
765 The City Drive South, #200
Orange, CA 92868
