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Yes, the program is free.

A grievance is a complaint you file when you are unhappy with your health care. It may be about the quality of care, how you were treated, or that your rights were not respected. You can file a grievance at any time.

An expedited (fast) grievance is when you ask your MCE to resolve the grievance quickly because waiting 30 days could harm your life, health, or ability to function. If the MCE agrees with the request, they must resolve the grievance within 48 hours.

An appeal is when you ask your MCE to review their decision  to deny or reduce a health care service. This is called an “adverse benefit determination.” You have 60 days from the date of the decision to file an appeal.

An adverse benefit determination is when the MCE:

• Denies or provides limited approval for a requested serivce.
• Reduces, suspends, or terminates (ends) a previously approved service.
• Denies payment for care or approves payment for less care than you asked for.
• Lowers the number of services you can get or stops paying for an approved service.
• Denies all or part of a payment for services.
• Did not give services in a timely way.
• Did not act in the required time.
• Denies your right to get services outside the provider network.
• Denies your request to dispute what you must pay for services or coverage.

An expedited (fast) appeal is when you ask your MCE to review their decision quickly because waiting 30 days could harm your life, health, or ability to function. If the MCE agrees with the request, they must resolve the appeal within 48 hours.

An external review is a review by a group outside your MCE. If you do not agree with the MCE's appeal decision, you can ask for an external review. An independent review organization (IRO) does the external review. The IRO reviews decide when an MCE denied services or said a service wasn’t medically necessary or was experimental or investigational. You have 120 days from the date of the MCE's appeal decision to file for an external review.

A state fair hearing is a hearing you can ask for if you disagree with the MCE grievance or appeal decision. You can ask for this hearing after you use all MCE grievances and appeals options.