Updates to the Internal Appeal process
Horizon NJ Health has a process for members who ask us to review and change our medical decision if we have denied or reduced their services. This is called an Internal Appeal. There is an update to when members can ask for a faster review time and how they can do so. If you or your treating provider believe the 30 calendar-day decision timeframe is too long and could harm your health, you can call us and ask for an expedited, or fast appeal.
During a fast appeal Horizon NJ Health will decide your Internal Appeal within 72 hours of receiving it. You may ask for a fast appeal:
- If you are an inpatient in a facility,
- if the care you received was for an urgent or emergency health concern, OR
- it is medically necessary and taking 30 calendar days to decide the appeal could seriously harm you in some way.
To ask for a fast appeal, please call 1-800-682-9094 x89606 (TTY 711), Monday through Friday, 8:30 a.m. to 5 p.m., ET.