You Can File an Appeal

We hope you will always be happy with the decisions we make about your health care. But if you are not, there is something you can do.You can file an appeal with Passport Health Plan. The appeal can be for medical or nonmedical reasons.

There are many reasons for filing an appeal. For example, you might file an appeal if you:

• Cannot get medicine your provider wanted you to have.
• Cannot have a surgery your provider thought you needed.
• See a provider or go to a hospital that is not signed up with Passport Health Plan.

The Appeal Process

Passport Health Plan will send you a denial letter that tells you why the service is not covered. If you disagree with the decision, you can file an appeal. You, your provider or someone else can file your appeal. If your provider or someone other than your approved representative files your appeal, you must give him or her written consent to do so. Your appeal must be done in writing, even if you ask for your appeal over the phone or in person. Passport Health Plan must receive the appeal within 30 days of the date of the denial letter. If you need help filing your appeal, please call Member Services, at 1-800-578-0603, press 0, then press 77307.

Your appeal should be sent to:

Passport Health Plan
Appeals Coordinator
305 West Broadway, 3rd Floor
Louisville, KY 40202

You may also ask for a State Hearing with DMS (Department for Medicaid Services). The State Hearing is not related to Passport Health Plan. Passport Health Plan must follow the DMS ruling. To ask for a DMS hearing, please write or call:

Division of Administrative and Financial Management
275 East Main St., 6W-C
Frankfort, KY 40621
1-800-635-2570

You also may contact Kentucky's Ombudsman at:

Cabinet for Health and Family Services
275 East Main St., 1E-B
Frankfort, KY 40621
1-877-807-4027

If you have a hearing impairment, please call the TDD/TTY number at 1-800-648-6056.