Appeals Process

If you have a problem or concern about OhioHealthy, your quality of care, services or our policies and procedures, contact a Member Advocate.

OhioHealthy has a formal process to address concerns with the appropriate departments and people. Research into your concerns will be conducted in a timely manner to accommodate any clinical urgency. If your concern involves a denial of a covered service or claim, we include a formal appeals process. You will be notified when your concern is resolved.

You may be eligible for a routine appeal or an expedited appeal if an emergency medical condition exists. Download an appeal packet or contact a Member Advocate at the number listed on your member ID card to initiate the appeals procedure.

Steps to Take When Initiating an Appeal

To initiate the appeal process, submit your request in writing to:

OhioHealthy
Appeals Department
P.O. Box 62876
Virginia Beach, VA
23466-2876

Or

Fax: (757) 687.6232 or 1 (866) 472.3920

You or your authorized representative have the right to submit written comments, documents, records or any other information relevant to your case. If you have difficulty obtaining this information, please contact our Appeals Department for assistance.

Relevant information includes:

  • The Appeal Request Form describing the services or procedures requested and an explanation of why you feel OhioHealthy's decision was incorrect.
  • Office notes from physicians that you have seen regarding the services or procedures in question.
  • Medical records from hospitals and other healthcare providers.
  • Physician correspondence.
  • Physical, occupational or rehabilitative therapy notes.
  • Copies of bills you have received.
  • Any additional information you would like OhioHealthy to consider in reviewing your appeal.

When we receive your written request, you will have 10 days to submit any additional medical information. Documentation received after the tenth day may not be considered in your appeal review.