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Filing an Appeal

How to file an appeal

An appeal is when you, your provider, or your representative are not satisfied with the result of a decision made by MHS and wish to take action. This may be because you are not happy with the results of a grievance you filed, OR because you are not happy with a decision MHS made when your doctor asked for prior authorization or prior approval for some treatment, therapy, medical equipment, prescription or other medical service. To name a representative or your provider, send MHS a signed letter or consent form telling us who will be your representative.

Appeals need to be filed within 60 calendar days from the date on the letter telling you about the decision. A member or the member’s representative may write, phone, fax, or email the appeal request and consent to:

Your written appeal should include: 

  • Your name, phone number, address, and signature 
  • Your Hoosier Care Connect member identification number.
  • The reason(s) why you are unhappy.
  • How you want MHS to help.

You can present copies of papers that support your case in person or in writing.

MHS will write to you within three business days to say we received your request. Your case will be assigned to a person with the right qualifications to review your case, such as a physician or administrative manager. The person assigned will not have been involved in the original decision, or the decision at the previous review.

All appeals are resolved within 30 calendar days. The result is sent to you in writing within 5 business days of the decision. MHS may ask for an extra 14 business days to make a decision. If we need more time, we will let you know in writing before the 30 business day deadline.

If you are not happy with the result of your appeal, you may have the right to an external, independent review.

Expedited Review

If waiting the regular time for the answer to the appeal would put you at risk of serious bodily harm or injury, you may ask MHS to consider doing an extra fast review. This is called “expedited review.” To ask for expedited review, call or write to MHS as soon as possible. MHS resolves expedited reviews within two calendar days (48 hours).

Last Updated: 01/21/2021