Other Important Information
Health Parity Laws
Coventry Health Care Louisiana, Inc. ("Coventry") is currently in compliance with existing health parity requirements, including mental health/substance usage disorders, applicable to the health plan. Coventry's legal and compliance teams monitor for any new legislative or regulatory changes to these existing requirements, communicate any change to our health benefits administration team, and update our health plan documents as necessary to comply with the change.
Coventry Health Care of Louisiana, Inc. may contract with certain vendors, directly or indirectly, to perform services on its behalf. We oversee and maintain responsibility for these contracted services. Our current contracted services that directly relate to the administration of our benefit plans include: behavioral health and substance use disorder services (MHNet), pharmaceutical management services (Medco/Express Scripts), pain management utilization (Triad), nurse advice line services (McKesson), and certain provider credentialing services.
Complaints and Appeals
Complaint and appeal policies are in place to ensure that we have effective procedures for addressing, documenting, and resolving complaints or appeals.
The complaint procedure gives a member the right to express dissatisfaction with any aspect of the organization and to request review of any matter related to:
- The quality of health care service received
- General inquiries about covered services
- Member rights and responsibilities
The appeals procedures give members the opportunity to ask us to review any matter related to:
- Issues about the scope of coverage for health care services
- Medical necessity of services requested
- Denial of care/services/claims
- Other adverse benefit determinations
Notice of Appeal Rights
It is the policy of CHC-LA as well as the Department of Labor and the State of Louisiana that all members shall have the right to appeal any adverse decision made by the Plan. You may represent yourself in your appeal or you may designate a representative. Your provider may appeal on your behalf, likewise a hospital who is responsible for your care may also file an appeal. You may call the Member Services Department at 800-341-6613 for further assistance regarding the appeal process. You have the right to appeal in writing or by telephone.
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