Making an Appeal

If you are not satisfied with an organization/coverage decision we made, you can appeal the decision. An appeal is a formal way of asking us to review and change an organization/coverage decision.

Appeals Process

1. To file an appeal, please contact the Plan by calling Member Services at 855-969-5882 (TTY: 711). You can also send your request to our Appeals Department by mail or fax at:

Prominence Health Plan
Grievance and Appeals Department
1510 Meadow Wood Lane
Reno, NV 89502
Phone: 866-969-5882
Fax: 775-770-9004

2. We will review the decision we made to check that we followed all the rules properly.
3. Once we have completed our review we will send you our decision.
4. If we deny all or part of your Level 1 Appeal, you can proceed to a Level 2 Appeal. The Level 2 Appeal is conducted by an independent organization that is not connected to our Plan.
5. If you are not satisfied with the result of the Level 2 Appeal, you may be able to continue through several more levels of appeal.

For detailed instructions on the appeals process, please see the “What to do if you have a problem or complaint (coverage decisions, appeals, complaints)” section of your Evidence of Coverage. The Evidence of Coverage (EOC) is a comprehensive resource guide to your healthcare coverage and is considered a legal document.

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Last update 9/25/2019