State Fair Hearings
If you don’t agree with a decision we made that reduced, stopped or restricted your services after you receive our decision about your appeal, you can ask for a Fair Hearing from North Carolina. A Fair Hearing is your chance to give more information and facts, and to ask questions about your decision before a judge. The judge in your Fair Hearing is not a part of your health plan in any way.
- You can ask for a fair hearing within 120 days from the day you hear from us about our decision about your appeal.
- When you request a Fair Hearing, you can also ask for an opportunity to mediate your disagreement. Mediation is an informal voluntary process to see if we can come to an agreement on your case. You do not have to ask for mediation to receive a Fair Hearing. Mediation is guided by a mediator who does not take sides. If we do not reach an agreement, you can still have a Fair Hearing. You can also decide not to go through mediation and just ask for a Fair Hearing.
HOW TO REQUEST A STATE FAIR HEARING
MAIL: Fill out and sign the State Fair Hearing Request Form that was with your Notice. Mail it to both of the addresses listed on the form. OAH must receive your form no later than 120 days after the date on the notice.
FAX: Fill out and sign the State Fair Hearing Request Form that was with your Notice. You will find the fax numbers listed on the form.
BY PHONE: Call Carolina Complete Health at 855-552-3876 and ask for a State Fair Hearing. You will receive assistance to complete your form during this call.
IF YOU ASKED FOR A SERVICE YOU NOW RECEIVE TO CONTINUE UNTIL YOUR FAIR HEARING IS DECIDED
You asked for a State Fair Hearing because Medicaid stopped or reduced a service you are getting now. If you asked for that service to continue until your Fair Hearing is finished there will not be an interruption in your service. You will receive the service until you have a decision. If the judge agrees with Carolina Complete Health’s decision to reduce, deny or end your service, you may be required to pay for the services that were extended during your appeal.
IF YOU NEED A STATE FAIR HEARING REQUEST FORM
You can get a copy of the Fair Hearing Request Form by calling Carolina Complete Health at: 855-552-3876.