If you do not agree with this decision, we encourage you to call the
health plan directly so that they can discuss their decision with you. You will find their toll-free number on the letter that you 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 for an impartial review within 30 days of the date of the letter. Send your written request to the address listed on your letter and submit all of the following in your request:
- 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 Insurance Department, 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, visit the
IRS website.