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.

Call us at 1-800-500-3373
Fax us at 217-337-8009

Mail us your appeal in writing to:
FirstCarolinaCare Insurance Company
Attention: Appeals and Grievance Department
42 Memorial Dr.
Pinehurst, NC 28374
Fax: (816) 313-3061

The following document links contain detailed information on how to file an appeal, a grievance/complaint, or appoint a representative to file the complaint on your behalf and the link to the appeals and grievance form.

Appeals & Grievances Form

Appointing a Representative

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 1-800-851-3379 (TTY 711).

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.