Appeals

APPEALS PROCESS

Your plan offers you an appeals process if you have been denied care. You may call VIVIO Health for details at 1-800-470-4034 or find the details at MyVIVIO.com/appeals.

Appeals administration

If a member or physician requests an appeal and additional information is provided, it is reviewed and evaluated by the VIVIO Health appeals unit to determine if the drug use meets coverage conditions specified or intended by your employer according to the procedures set
forth below:

Level 1: The VIVIO Health Appeals Unit
Level 2: The VIVIO Health Appeals Unit or external third party review organization
Level 3: Review by Independent Review Organization (IRO)

Appeal procedures apply to appeals of adverse benefit determinations of appropriateness, effectiveness and experimental classification of a specialty drug therapy. Appeals related to eligibility to participate in the plan are coordinated by your employer.

For complete information, download VIVIO Appeals Process