What you can do if you do not agree with our decision.
If our decision is that we agree completely or partially with the health plan, you may have rights to a Hearing with an Administrative Law Judge (ALJ). This is called an ALJ Hearing. An ALJ Hearing is a meeting with you, the ALJ and the Health Plan so that you can talk about your appeal. It is usually held by telephone or video conference.
You can have an ALJ Hearing if the amount of money at stake in your appeal satisfies the Amount in Controversy (AIC) requirement. To find out more about the AIC please visit: https://www.hhs.gov/guidance/document/third-level-appeal-decision-omha
To ask for an ALJ Hearing, fill out the ALJ Hearing Request form.
You can send your signed form to us using any of these methods:
Fax the signed form to: 585-425-5292
Scan and email the signed form to: email@example.com
Mail the signed form to:
Medicare Managed Care & PACE Reconsideration Project
3750 Monroe Avenue
Pittsford, NY 14534-1302
You must send the ALJ Hearing request to us within 60 days of the date of the Maximus decision letter.