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.
- 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
- We will review the decision we made to check that we followed all the rules properly.
- Once we have completed our review we will send you our decision.
- 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.
- 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.