Yes. If you do not agree with this decision, we encourage you to call your CHIP health plan first so that they can discuss their decision with you. You will find their toll-free number on the letter that you have received. After you talk to them, if you still do not agree with their decision, or if you choose not to call them to discuss the decision, you may submit a written request to them for an impartial review within 30 days from the date of the letter. You can send your written request to the address listed on your letter. Please submit all of the following promptly:
- a written, dated request stating why you disagree with their decision
- a copy of the entire letter you received
- any additional documentation to support your case
- a phone number where you can be reached during the day
They may contact you for more information. If they cannot resolve your issue, they will forward your written request and any additional information to the Pennsylvania Department of Human Services. You may also receive more detailed information from the Pennsylvania Department of Human Services, including the time and date that a phone interview will be held, if needed.
It is important that you provide this information and respond promptly to prevent any break in insurance coverage. If you have a break in insurance coverage, you may be assessed a tax penalty from the federal government. For more information about tax penalties go to www.irs.gov for details.