Appeals Process for Commercial Product Pre-Service Adverse Determinations
In the event that a patient, patient’s designee or attending physician chooses to appeal an adverse determination of any Commercial Product pre-service request, the decision may be appealed to HCP.
You can notify us in the following ways:
- By telephone, by contacting the HCP Customer Engagement Center at (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 decisions will be made within 2 business days of receipt; Standard Appeal 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 the instructions found in the Determination letter.
