The deadline to file a request for an external appeal/review after receipt of an adverse benefit determination or final internal adverse benefit determination is 130 days from HMAA’s Internal Appeals Decision, which may be extended in certain circumstances as described in the following example:
- Example 1: On May 11, 2020, Marie received notification from HMAA that the appeal she submitted while covered under her HMAA plan was upheld/denied, her internal appeal rights were exhausted, and she was provided her rights for external appeal/review. When does Marie need to file a request for an external review of HMAA’s appeal determination? For purposes of determining the period applicable to Marie’s external review request, the Outbreak Period is disregarded. Marie’s request will be deemed timely as long as she submits her request for external review within 130 days from the one-year extension date that the timeline would have started (May 11, 2021), in this case by the deadline (September 18, 2021).