This is usually a formal process in which both the consumer and the funding source submit written information supporting their point of view. The individual designated to review the information then makes a decision in favor of one of the two parties.
All governmental agencies have appeal processes.
The lowest of the three is usually chosen. In this manual, an individual who is eligible to participate in, and receive benefits from, a particular program. The amount an individual must pay for each health care service provided. A part, or percentage, of the overall cost. The specific dollar amount an individual must pay before an insurance company will begin paying for health care services.