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This document outlines the process for requesting an internal first level review and an external second level review regarding delays, denials, reductions, terminations, or suspensions of Health Choice services for children. It provides details on timelines, contact information for relevant agencies, and instructions on submitting review requests.
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How to fill out health choice review request

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How to fill out health choice review request

01
Obtain the health choice review request form from your healthcare provider or insurance company.
02
Fill in your personal information, including your name, address, and contact details.
03
Provide information about your insurance policy, including policy number and coverage details.
04
Clearly describe the service or treatment you are requesting a review for.
05
Include any relevant medical documentation or evidence to support your request.
06
Sign and date the form to confirm that the information provided is accurate.
07
Submit the completed form to the appropriate department, either via mail or online, as instructed.

Who needs health choice review request?

01
Individuals who have had a service denied by their insurance provider.
02
Patients seeking a second opinion or review of treatment options.
03
Those who wish to appeal healthcare decisions made by their insurance company.
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A health choice review request is a formal submission seeking an evaluation or determination regarding an individual's health insurance coverage or benefits.
Individuals who wish to challenge a denial of coverage or seek clarification regarding health insurance benefits are required to file a health choice review request.
To fill out a health choice review request, individuals need to complete the designated form with accurate personal information, details of the insurance policy, and specific reasons for the request.
The purpose of a health choice review request is to allow individuals to formally appeal decisions made by their insurance providers regarding coverage and benefits.
The request must include the individual's name, policy number, contact information, details of the claim or service in question, and the reasons for the appeal.
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Health Choice review process denial services suspension internal review external review North Carolina Department of Health and Human Services children's health services expedited review

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