What if I don’t agree with decisions by MetroHealth Care Plus?

You have the right to appeal a decision not to provide you or pay for an item or service (in whole or part). If a decision by MetroHealth Care Plus denies, reduces or ends your health care coverage, you can appeal the decision.

How do I file an appeal?

You may file an appeal by contacting MetroHealth Care Plus within 90 working days of the decision to ask that MetroHealth Care Plus change its decision.  You can appeal by calling 216-957-2490; by writing to The MetroHealth System, Attn: MetroHealth Care Plus, 2500 MetroHealth Drive, Cleveland, Ohio 44109-1998; or by e-mail at mhcpappeals@metrohealth.org. You may also fax your appeal to 216-957-2403.

What happens next?

If you appeal, we will review our decision and provide you with a written decision within 15 calendar days of receiving your appeal.

If you are not satisfied with the MetroHealth Care Plus answer to your appeal, you may request a reconsideration of your appeal by contacting MetroHealth Care Plus within 15 working days of the appeal decision.

You can request a reconsideration by calling 216-957-2490; by writing to The MetroHealth System, Attn: MetroHealth Care Plus, 2500 MetroHealth Drive, Cleveland, Ohio 44109-1998; or by e-mail at mhcpappeals@metrohealth.org. You may also fax your appeal to 216-957-2403.

A meeting will be held within 10 calendar days (or the next day, if the tenth day is a holiday or weekend) of MetroHealth Care Plus receiving your reconsideration request.  MetroHealth Care Plus will provide you with a written decision within 3 calendar days (or the next day, if the third day is holiday or weekend).

If you are not satisfied with the MetroHealth Care Plus answer to your reconsideration, you may request a state hearing by contacting the Ohio Department of Job and Family Services (ODJFS) within 90 working days of the reconsideration decision. You can request a State Hearing by calling 1-866-635-3748; by writing to the Ohio Department of Job and Family Services, Bureau of State Hearings at P.O. Box 182825, Columbus, Ohio 43218-2825; by email at BSH@jfs.ohio.gov; or by faxing your hearing request to State Hearings at 614-728-9574.

You may also request a state hearing by contacting MetroHealth Care Plus by calling 216-957-2490; by writing to The MetroHealth System, Attn: MetroHealth Care Plus, 2500 MetroHealth Drive, Cleveland, Ohio 44109-1998;  by e-mail at mhcpappeals@metrohealth.org; or by fax at 216-957-2403.