Appeals and Utilization Management
Appeals
If you have a complaint or are unhappy with coverage for care or a service being denied, in certain situations, you have the right to file an appeal.
To Start an Appeal
If you have a Medicare complaint, go here.
To initiate an appeal or grievance you can call the member services number on your member ID card.
Mail us your appeals in writing to:
FirstCarolinaCare Insurance Company
ATTN: Appeals Dept
3310 Fields South Dr.
Champaign, IL 61822
Fax (217) 902-9708
The following document link contains detailed information on how to appoint a representative to file an appeal or grievance on your behalf.
Utilization Management
Utilization Management (UM) helps us work with your doctors to give you the right care, at the right time, and in the right setting.
How Do I Request a Review?
To start the review process, call us at (800) 481-1092.
Preservice Review
A preservice review is when we review our coverage of medical care or services before you get that care. Care and services that require this approval are in your policy, or you can log in to Hally.
Urgent Concurrent Review
An urgent concurrent review is when we review our coverage of medical care or services while you're in the process of receiving that care, even if it was not approved before you started receiving the service.
Postservice Review
A postservice review is when we review our coverage of medical care or services that you've already received.