Integrated appeal

Integrated appeal means any of the procedures that deal with, or result from, adverse integrated organization determinations by an applicable integrated plan on the health care services the enrollee believes he or she is entitled to receive, including delay in providing, arranging for, or approving the health care services (such that a delay would adversely affect the health of the enrollee), or on any amounts the enrollee must pay for a service. Integrated appeals cover procedures that would otherwise be defined and covered, for non-applicable integrated plans, as an appeal defined in 422.561 or the procedures required for appeals in accordance with 438.400 through 438.424 of this chapter. Such procedures include integrated reconsiderations.


42 CFR § 422.561

Scoping language

As used in this subpart, unless the context indicates otherwise -

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