How to File a Complaint

You may file a complaint with Nevada Health Link (NVHL) if you are dissatisfied with any aspect of your experience working with NVHL concerning eligibility, enrollment, carrier service, enrollment assisters, agents/brokers or the call center.  While filing a complaint is more of an informal procedural process, every complaint received by the NVHL is serviced in a professional and courteous manner in an effort to arrive at the most fair and timely resolution possible.  If you wish to file a complaint, please call our customer service department at 1-800-547-2927.

What Happens Next Regarding Your Complaint

Nevada Health Link will acknowledge your complaint within 72 business hours of receipt.

We will undertake an initial review of the complaint and determine what, if any, additional information or documentation may be required to complete a review. This may include contacting the complainant or others to clarify details or request additional information as appropriate.

At the conclusion of our review process, NVHL will notify the consumer of findings and any actions taken, or proposed to be taken, in regards to the complaint.

How to File an Appeal

If you are unhappy with the complaint resolution, or think the eligibility decision about your health insurance coverage is wrong, you have the right to file an appeal with Nevada Health Link within 90 days of the date of eligibility determination on eligibility correspondence you receive from NVHL.  An appeal is a more formal process that may ultimately end in a formal appeals hearing. Please note: the 90-day timeline begins on the date of your eligibility determination notice, NOT the date on a complaint response.

  • You have a right to appeal if you think Nevada Health Link (NVHL) made a mistake about:
    • Initial or re-determination of eligibility, including the amount of advance payments of the premium tax credit and level of cost-sharing reductions;
    • Failure by the Exchange to provide timely notice of an eligibility determination;
    • Denial of a request to vacate dismissal made by the Exchange’s appeals entity, and
    • An appeal decision issued by the Exchange’s appeals entity.

    Instructions

    You have ninety (90) days from the date on your Eligibility Notice to file an appeal. The date of the postmark on your appeal envelope or the date your email is received is considered the date you filed your appeal.

    Your Eligibility Notice explains whether you qualify for financial assistance to purchase insurance on Nevada Health Link. Depending on your eligibility results, you may appeal.

    Do you need assistance completing this appeals request?

    You can choose an authorized representative.

    You can give a trusted person permission to communicate about this appeal with us, see your information, and act for you on matters related to this appeal, including getting information about your appeal and signing your appeal on your behalf. This person is called an “authorized representative.” If you do not already have an authorized representative, you can print the form below and submit with your supporting documentation.

    • Date Format: MM slash DD slash YYYY
      • An appeal can be expedited when the standard timeframe “could jeopardize the consumer’s life, health or ability to attain, maintain or regain maximum function” * 45 CFR 155.540(a) • Request for an expedited appeal needs to be noted on the appeal request where you “Explain the Reason for Your Appeal” Your request to expedite your appeal will be processed as quickly as possible. A final decision will be made as quickly as your situation requires.
    • Your explanation should state the reason for your appeal, including relevant dates and account history. List any actions or communications you attempted to resolve your request prior to the appeal. Please provide additional documentation such as notices received. If your appeal request affects or impacts other members of your household, note their names and how they are impacted here.
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        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 attaching and returning it with this form or by mailing it separately to: Nevada Health Link Attn: Appeals 2310 S. Carson St. Suite. 2 Carson City, NV 89701 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.
      • The information in this section applies to all people signing above, including the Claimant. I further understand that by completing, signing, and dating below, I authorize Nevada Health Link to disclose information collected based on my application and from other data sources that may have been used to make the eligibility determination. I understand that this information may be disclosed for use during the appeals process. The authorization is valid until the appeal is concluded or I notify Nevada Health Link otherwise. I understand by completing, signing, and dating above, I authorize Nevada Health Link to disclose information in my eligibility record, based on the application I filled out, and from other data sources that may have been used to make the eligibility determination, to my authorized representative and other household members whose signatures are provided below. I understand I may request a copy of my eligibility record during the appeals process. The authorization is valid until the appeal is concluded or I notify you otherwise. I am signing this form under penalty of perjury, which means I have provided true answers to all the questions I have answered to the best of my knowledge. I know that I may be subject to penalties under state and federal law if I provide false information. I understand that I am not required to complete this form. I am voluntarily completing it to file an appeal request to Nevada Health Link. I understand that I am the primary contact for purposes of appealing these eligibility determinations.

      Notice of Privacy Practices

      Nevada Health Link is committed to maintaining the privacy and security of personally identifiable information. Nevada Health Link will use personally identifiable information only as permitted by Nevada Health Link’s policies and as required by law.

      More information about Nevada Health Link’s privacy and security practices and your rights is available on Nevada Health Link’s website at Nevada Health Link’s Privacy Policy

      If you need help understanding this form in another language, or if you are disabled and need help to use this form, please contact Nevada Health Link. There is no cost for assistance.

      Note: Healthcare.gov will be processing requests for exemptions.  For more information please visit https://www.healthcare.gov/health-coverage-exemptions/

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