You have the right to appeal your application results when you apply to buy a health plan or receive financial help from Connect for Health Colorado.
If you were denied Health First Colorado (Colorado’s Medicaid program) or CHP+, you must file an appeal with the county office in which you reside. Connect for Health Colorado cannot process appeals for Health First Colorado or CHP+.
Why File an Appeal?
To appeal means to ask for an assessment of the information listed in your application and the application results, to determine whether the application results are accurate.
Timeline to File an Appeal
You have 60 days from the date of your notice of determination- the letter which explains your application results- to submit an appeal request for yourself or anyone in your household who applied for health insurance or financial help.
Results that You Can Appeal with Connect for Health Colorado
- Your eligibility for Advance Premium Tax Credits (APTC) and/or Cost-Sharing Reductions (CSR)
- The amount of Advance Premium Tax Credits;
- The level of Cost-Sharing Reductions.
- Your eligibility to enroll in a Qualified Health Plan;
- Your eligibility for a Special Enrollment Period;
- Your eligibility for an exemption;
- A denial of a request to vacate a dismissal, an appeal decision issued by the State, or a failure of the Exchange to provide timely notice of an eligibility determination.
Disputes that You Cannot Appeal
- Coverage start dates and end dates.
- Information listed in your Form 1095-A.
- Health care services, such as the benefits your plan offers, access to doctors or specialists, or a denial of prior authorization for services.
Ways to File an Appeal
You can file an appeal in any of the following ways:
1. Online- log into your online Connect for Health Colorado account (under “Documents and Notices”) and upload the appeal request form.
2. Mail your completed appeals request form to:
Office of Appeals
4600 South Ulster Street
Denver, CO 80237
3. Fax your appeal to 303-322-4217.
Our Customer Service Center representatives can assist you in completing the form by answering questions objectively, however, they cannot fill out the form or submit it on your behalf.
After You File an Appeal
After you file an appeal, the Office of Appeals will notify you that your appeal has been received. From there, the Office of Appeals can evaluate your appeal through an informal review process, or they can schedule a formal hearing on your appeal with the Office of Administrative Courts.
During the formal hearing, the Office of Appeals will make a decision on your eligibility for a health plan or financial help based on the appeal, and any additional evidence you provide to support your appeal. You can bring someone with you to your hearing. That person can be a lawyer, a friend, or a family member.
If you disagree with the decision made by the Office of Appeals, you can appeal that decision to the U. S. Department of Health and Human Services within 30 days of the Office of Appeals’ decision.