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.