2023 Archdiocese of Atlanta Meritain Group Plan Doc - Manual / Resource - Page 50
and at no charge, the information used to review your second level appeal. The decision made on your second
level appeal is final and binding.
In the case of a claim for coverage involving urgent care, you will be notified of the benefit determination within 72
hours of receipt of the claim. An Urgent Care Claim is any claim for treatment with respect to which the application
of the time periods for making non-urgent care determinations could seriously jeopardize the life or health of the
claimant or the ability of the Claimant to regain maximum function, or in the opinion of a Physician with knowledge
of the Claimant's medical condition, would subject the Claimant to severe pain that cannot be adequately managed.
If the claim does not contain sufficient information to determine whether, or to what extent, benefits are covered,
you will be notified within 24 hours after receipt of your claim, of the information necessary to complete the claim.
You will then have 48 hours to provide the information and will be notified of the decision within 48 hours of receipt
of the information.
46