The Hospital Care Assistance Program can help alleviate the financial burden of medical expenses. If your application was denied or you believe you qualify for a larger award, you have the option to appeal the decision. This guide outlines the steps and necessary documentation for appealing your application.
Appealing a Denied Hospital Care Assistance Program Application
You have 30 days to file an appeal after your initial application is denied. After this period, you will need to submit a new application. To begin the appeal process, you’ll need to provide your full name and email address through the designated online form. Once submitted, you will receive further instructions via email on how to formally file your appeal.
Several reasons may justify an appeal, such as a recent job loss or a significant change in your financial situation. To support your appeal based on financial hardship, you must provide:
- Reason for Appeal: Clearly explain why you are appealing the initial decision.
- Current Financial Documentation: Provide comprehensive documentation of your total gross household income, supporting your claim for financial assistance. Accepted documentation may include pay stubs, tax returns, or official unemployment documents.
You can also appeal if your medical expenses exceed 10% of your annual gross household income over the previous 12 months. In this case, you’ll need to provide:
- Proof of Annual Gross Household Income: Submit documentation verifying your total household income for the past year.
- Proof of Non-Kaiser Permanente Medical and/or Dental Expenses: Provide detailed proof of medical and dental expenses incurred outside of Kaiser Permanente.
- Itemized Bills: Include itemized bills from healthcare providers with the following information: provider’s name and address, patient’s name, and a detailed description of the services or supplies provided.
Appealing for a Larger Award and Submitting Documentation
If you believe you qualify for a larger award, you can appeal at any time before the current award’s end date. Whether appealing a denial or requesting a larger award, ensure your documentation is complete and accurate. Refer to the program guidelines for a comprehensive list of acceptable income documentation.
If you initially omitted required financial documents or if your income has changed, you can submit additional documentation. To submit your appeal via fax or mail, complete the Appeal Request form included with your award letter and include all supporting documentation.
You can submit your appeal letter and documentation to:
- Fax: 1-800-687-9901
- Mail: Kaiser Permanente MFA Program P.O. Box 30006 Walnut Creek, CA 94598
Remember to send copies of official documents, not originals. On the first page of your proof of income, clearly write your first and last name, medical record number (if applicable), home address, and date of birth.
Hospital Care Assistance Program Appeal Decisions
Once the necessary documentation is received, you will receive a letter regarding the decision on your appeal within 30 days. Appeals submitted without any additional information will be automatically denied. All appeal decisions are final. Be sure to gather all necessary documentation to support your appeal and submit it within the 30-day timeframe. This will ensure your appeal receives thorough consideration. Contact the Hospital Care Assistance Program directly if you have any questions about the appeal process.
