If you have a request for coverage or complaint of any kind, we want to know about it so we can help to resolve your concerns. There are different types of coverage requests and complaints. We have provided you with a quick list for your reference and contact information to help you get started.
At El Paso Health+ Advantage Dual SNP (HMO SNP), we understand that navigating through complicated rules can be frustrating. So any time you have a question, we want you to give us a call. Our Customer Experience Center Representatives are trained to help you with all your health plan needs.
Coverage Requests, Appeals, and Complaint
Organization Determinations – You can request El Paso Health+ Advantage Dual SNP (HMO SNP) to make a decision on any type of service or a payment for medical care, such as surgery. This can be completed by you as a member or by the provider. El Paso Health Advantage Dual SNP (HMO SNP) can deny or approve the service. If we deny the service, there are appeals rights available to you.
How do I ask for an Organization Determination?
Call:
April 1—Sept. 30, from 8 a.m.-8 p.m. Mountain Time (MST) Monday through Friday.
Write:
El Paso Health + Advantage Dual SNP (HMO SNP)
Attention: Complaints & Appeals Department
What if my coverage or payment is denied?
Appeals – if we deny coverage or payment for an item, medical service or a prescription that you think we should cover or pay for, you may request an appeal. You can ask us to “expedite” or give you a quick decision if we have denied coverage (but not if your appeal is related to payment for services you already received).
How do I ask for an appeal for medical care?
Call:
October 1—March 31, from 8 a.m.-8 p.m. Mountain time (MT) Daily
• April 1—Sept. 30, from 8 a.m.-8 p.m. Mountain Time (MT) Monday through Friday.
Write:
El Paso Health+ Advantage Dual SNP (HMO SNP)
Attention: Complaints & Appeals Department
What if I was discharged from an inpatient hospital too soon?
Inpatient Hospital Discharge – if you think you are being discharged from the hospital too soon, you may request that the QIO (Quality Improvement Organization) review your discharge from the hospital.
