Post-decision options for partial or full denial decisions may vary based on the denial reason, health plan, member’s line of business or even the member’s residing state.

Patients should be encouraged to review their determination letter they receive by mail to understand the reasons the request was determined to be inappropriate, as well as what post-decision options might be available to them regarding partial or full denial determinations. As their provider, however, it is encouraged that you also review the determination and options available, as you may be able to act on your patient’s behalf more quickly.