What is an appeal?
An appeal is a formal request for someone to change a decision. In this booklet, appeal means a request for the regional center to change its decision about a person’s eligibility for services or about the services the person receives. The appeal request can come from a person already receiving regional center services, or from a person who is applying for regional center services. The request can also come from a parent, legal guardian or conservator, or from someone else who is helping that person work with the regional center and other service agencies.
Why use the appeal process?
The appeal process is used to settle differences between your health insurance company and a client or family. The differences can be about four kinds of decisions.
- When an assessment is completed and the insurance company decides that a person is not eligible for services, and the person or his family disagrees with that decision.
- When the health insurance company decides that a person is no longer eligible for services and the person or his family disagrees with that decision.
- When a client or family asks for a new service and the health insurance company denies the request.
- When a service or support is reduced, changed, or ended and the client or family disagrees with this change.
THERE ARE TIMELINES AND PROCESSES FOR ALL HEALTH INSURANCE COMPANIES, IN THE EVENT YOU WANT TO FILE AN APPEAL, WE CAN ASSIST WITH THIS PROCESS.