If you do not agree with your health plan’s decision to deny, reduce, stop or limit your services, you may ask for a State Fair Hearing from North Carolina Office of Administrative Hearings (OAH). In North Carolina, State Fair Hearings include an offer of a free and voluntary mediation session. This meeting is held before your State Fair Hearing date.

A fair hearing is your chance to give any updates and facts about your case and to ask questions about your appeal. The judge in your Fair Hearing is not a part of your Partners Tailored Plan in any way.

• You can ask for a fair hearing within 120 days from the day you hear from us about our decision on your appeal.
• When you request a Fair Hearing, you can also ask for an opportunity to mediate your disagreement. Mediation is an informal voluntary process to see if we can agree on your case. Mediation is guided by a mediator who does not take sides. If we do not reach an agreement, you can still have a Fair Hearing. You can also decide not to go through mediation and just ask for a Fair Hearing.

It is easy to ask for a State Fair Hearing. Use one of the options below:

MAIL: Fill out and sign the State Fair Hearing Request Form that came with your notice. Mail it to all addresses listed on the form. OAH must receive your form no later than 120 days after the date on the notice.

FAX: Fill out and sign the State Fair Hearing Request Form that was with your notice. You will find the fax numbers listed on the form.

PHONE: Call the Office of Administrative Hearings (OAH) at 1-984-236-1860 and ask for a State Fair Hearing. You will get help with your request during the call.

You will get a notice if Partners Tailored Plan is going to reduce or stop a service you are receiving. You have 10 calendar days from the date we send the letter to ask for your services to continue. The notice you get will tell you the exact date. The notice will also tell you how to ask for your services to continue while you appeal.

If you ask for your services to continue, Partners Tailored Plan will continue your services from the day you ask for them to continue until you the day get your appeal decision. You or your authorized representative may contact Member and Recipient Services at 1-888-235-4673 or contact the Appeals Coordinator listed on your adverse benefit determination letter to ask for your service to continue until you get a decision on your appeal.

You can get a copy of the Fair Hearing Request Form by calling Partners Member and Recipient Services at 1-888-235-4673.