Model Notice of Adverse Benefit Determination

 The agencies release a Model Notice that can be used to advise of the denial of benefits under the Affordable Care Act.

Document Excerpt


This document serves as notice of an adverse benefit determination. We have declined to provide benefits, in whole or in part, for the requested treatment or service described below. If you think this determination was made in error, you have the right to appeal (see the back of this page for information about your appeal rights).

Link      iabdmodelnotice2


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