What if I need help understanding this decision?
Contact us [insert IRO contact information] if you need assistance understanding this notice.
What happens now?
If we have overturned the denial
, your plan or health insurance issuer will now provide service or payment.
If we have upheld the denial
, there is no further review available under the appeals process. However, you may have other remedies available under State or Federal law
, such as filing a lawsuit.
Other resources to help you:
For questions about your appeal rights
, this notice
, or for assistance
, you can contact [if coverage is group health plan coverage
, insert: the Employee Benefits Security Administration at 1-866-444-EBSA (3272)] [and/or] [if coverage is insured
, insert State Department of Insurance contact information]. [Insert, if applicable in your state: Additionally
, you can contact your consumer assistance program at [insert contact information].]