If we deny the appeal (continue to deny the services or treatment described in the denial letter), the member or someone acting on the member’s behalf and the provider of record has the right to request an independent/external review with Maximus within four months of receiving this letter. A member has the right to an immediate external review if Driscoll Health Plan does not issue a timely decision or if the member has a life-threatening condition.
Driscoll Health Plan uses the HHS-Administered Federal External Review process. Maximus manages the review process for HHS. Maximus does not have an affiliation with Driscoll Health Plan or your healthcare providers.
To request an independent/external review, you must complete the Maximus: HHS-Administered Federal External Review Request Form and sign the consent to release medical information to Maximus (included within the form).
You may fax the form to 1-888-866-6190 or mail to:
HHS Federal External Review Request
MAXIMUS Federal Services
3750 Monroe Avenue, Suite 705,
Pittsford, NY 14534
Submit a request via the online portal.
Members may have another person ask for an external review on their behalf. Both the member and the member’s authorized representative will need to complete and sign the HHS Federal External Review Process Appointment of Representative (AOR) Form. You may access the form by visiting www.externalappeal.com.
If you have questions about your external review or to request an AOR Form, please call 1-888-866-6205.