The deadline to file an appeal of an adverse benefit determination under HMAA’s claims procedures is 365 days from the initial adverse determination (AD), which may be extended in certain circumstances as described in the following example:
- Example 1: Angela received a denial by HMAA for a procedure she received while covered under her HMAA plan. The denial is dated February 19, 2021. If Angela decides to appeal the adverse benefit determination, when will she need to submit her appeal to HMAA? For purposes of determining the appeal deadline, the Outbreak Period is disregarded. Angela’s appeal will be deemed timely as long as she submits it within 355 days* after the end of the Outbreak Period (February 28, 2022), in this case by the deadline (February 18, 2023). *Timeframe calculation: 365 days (Standard) – 10 days (utilized prior to outbreak period) = 355 days remaining.