What Is An Appeal?
The State Department of Mental Health (DMH) defines an appeal as a request for review of an action. An action occurs when the Mental Health Provider (MHP) does at least one of the following:If you are unsure if any of these listed applies to you, please contact a Quality Assurance Specialist for clarification by calling (209) 381-6812. While your appeal is pending, you are entitled to still receive benefits.
- Denies or limits authorization or a requested service, including the type or level of service
- Reduces, suspends, or terminates a previously authorized service
- Denies, in whole or in part, payment for a service
- Fails to provide services in a timely manner, as determined by the MHP
- Fails to act within the time frames for disposition of standard grievances, the resolution of standard appeals, or the resolution of expedited appeals
How Do I File An Appeal?
Within 90 days of receipt of an action, you may complete an Appeal Form. If you wish to have assistance by Behavioral Health staff, you do not have to complete an Appeal Form in writing. You will be required to sign the Appeal Form before it can be submitted.
Where Do I Get An Appeal Form?
Appeals Forms are available at all Merced County Department of Behavioral Health clinic sites. You can also ask any Behavioral Health employee for this form or download it electronically.
If you need additional assistance, contact one of the following Behavioral Health staff for further information:
- Quality Improvement Manager Ph: (209) 381-6806
- Quality Assurance Specialist Ph: (209) 381-6812
- Patients' Rights Advocate Ph: (209) 381-6876
- Toll Free Ph: (888) 334-0163