Family Care, Family Care Partnership, and PACE: Filing an Appeal with Your Managed Care Organization

Have you received a notice of adverse benefit determination for termination, denial, or reduction of your services from your managed care organization (MCO)? Did it stop, deny, or reduce your services for:

• Family Care?
• Family Care Partnership (Partnership)?
• PACE (Program of All-Inclusive Care for the Elderly)?

If yes, and you don’t agree with the decision, you can file an appeal. You have the right to appeal to your MCO’s grievance and appeal committee. You can:

• Appear in person.
• Bring support, such as a friend, family member, or witness.
• Give evidence to the committee.

Before you request an appeal, talk to your care manager or MCO member rights specialist. They may resolve your concern without an appeal. This is called informal resolution. It’s often faster for members.

How to file an appeal

To start the appeal process, either:

• Contact your care manager or member rights specialist at your MCO. See Family Care MCOs Key Contacts (PDF).
• Fill out and send in a request form. Find the form for your MCO in your language:
  • Appeal Request—MCOs, English, F-00237
  • Appeal Request—MCOs, Arabic, F-00237AR
  • Appeal Request—MCOs, Chinese (Simplified), F-00237CM
  • Appeal Request—MCOs, Hmong, F-00237H
  • Appeal Request—MCOs, Laotian, F-00237L
  • Appeal Request—MCOs, Serbo-Croatian, F-00237SE
  • Appeal Request—MCOs, Somali, F-00237SO 
  • Appeal Request—MCOs, Spanish, F-00237S