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Appeals Process

Appeals Process Commercial Products Pre-Service Denials

In the event that a patient, patient’s designee or attending physician chooses to appeal a denial (adverse determination) of any Commercial Product pre-service request, the decision may be appealed to HCP.

You can notify us the following ways:

  • By telephone by contacting the HCP Customer Engagement Center at 1(800) 877-7587
  • By submitting a written Appeal request via FAX to 888-746-6433 .
  • Additional instructions, including a mailing address for those without access to FAX or phone, can be found in the Determination Letter.

Important: When an appeal request is submitted by someone other than the patient, an Appointment of Representation form must be signed by the patient and submitted via fax or mail at the same time the appeal is requested.

Expedited Appeal decision will be made within 2 business days of receipt, Standard Appeals decisions will be made within 30 days of receipt.

Medicare and Medicaid products, pre-service denials, and all products’ Concurrent denials are handled by the health plans. Please follow instructions found in the Determination letter.