What is an Appeal

An appeal is a request from an applicant, member, provider, health plan, or other approved entity to reconsider or change a decision, also known as an action.

An action includes any denial, reduction, suspension, or termination of a service or benefit, or a failure to act in a timely manner.

Examples

• Denial of request for surgery
• Denial of a request for a wheelchair
• Denial of basic heath care services
• Denial or discontinuance of AHCCCS eligibility

Note: This is not a complete list.