Appeals Next Steps

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Next Steps

  1. Acknowledgment of Appeal Request: The Exchange will send you a letter confirming receipt of your Appeals Request Form. This letter will provide you with an explanation of your health coverage while your appeal is pending. If there is a problem with your appeal request, such as missing information or the need for additional clarification, we will inform you by separate letter and permit you to correct the issue within a specific time frame.
  2. Review of your information: The Exchange will review your appeal request and any additional information you submit, along with the information we used to originally determine your eligibility. We may contact you to request additional information or to discuss your appeal. You have the right to review the information being used to resolve your appeal, including the information in your electronic account.
  3. Informal resolution: The Exchange may be able to resolve your appeal informally. After reviewing all your information and discussing your appeal with you, as necessary, we’ll send you an informal resolution decision. If you are satisfied with this informal resolution decision, we will implement the decision and close your appeal.
  4. Hearing: If you are dissatisfied with the outcome of the informal resolution process, you may continue with your appeal and your right to an appeal hearing is preserved. You must notify Nevada Health Link within ten (10) days of the date of your informal resolution decision to schedule your appeal hearing. You will be provided with written notice of the date, time, location and format of the hearing no later than fifteen (15) days prior to the hearing date.  The appeal hearing will be an evident hearing in front of a Hearings Officer consisting of members of the Division of Welfare and Supportive Services. You will be provided an opportunity to bring witnesses to testify, present evidence and argument, and cross-examine adverse witnesses. You also have the right to review all the information that the Hearings Officer will be considering for your appeal, including any information on your account. You may participate in the hearing by yourself or have someone participate in the hearing with you. This person can be a friend, relative, lawyer, your authorized representative (if you have one), or another individual. The Hearings Officer will review and consider the information used to determine your eligibility as well as any additional relevant facts and evidence presented during the appeals process, including at the hearing. The Hearings Officer will then issue a final decision on your appeal which will be mailed to you.
  5. Submitting additional information: You may submit additional information to support your appeal. Information you submit will be reviewed along with the information you submitted previously. You may submit additional information in advance of your appeal hearing by mailing it separately to:

Nevada Health Link 
Attn: Appeals
2310 S. Carson St. Suite. 2
Carson City, NV 89701

Email Contact: NVHLappeals@exchange.nv.gov

If you mail additional information separately, include the complete contact information of Claimant (as it appears on this form), including name, date of birth, phone number, email address (optional), and address. Additional information may also be submitted at the time of the appeal hearing.

  1. Requesting an expedited appeal: If you have an immediate need for health services and a delay could seriously jeopardize your health, you can ask for an expedited appeal by indicating in the ”Explain the Reason for Your Appeal” section that you are requesting and expedited appeal.
  2. Health coverage during your appeal: You may be able to keep your eligibility for coverage while your appeal   is pending.   Our   letter acknowledging   receipt   of your appeal   will provide you with an explanation of your health coverage while your appeal is pending. If you are currently enrolled, you may be liable for any payments due to the carrier during the appeal processing time. If you request an adjusted effective date, you may be obligated to any outstanding payments due to the carrier during the appeal processing time.
  3. Language assistance services: If you need language assistance in a language other than English, you have the right to get help and information in your language at no cost. Call the Nevada Health Link Call Center at 1-800-547-2927 to access these language assistance services.
  4. Accessibility: If you have a disability and need a reasonable accommodation, call Nevada Health Link at 1-800-547-2927 to request accommodations. These accommodations are available and provided at no cost to you.

Where can I find more information? Email Nevada Health Link at: NVHLappeals@exchange.nv.gov

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