Health Advocacy

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Disease Management and Complex Case Management

Special Programs to Help You with Your Health

Nevada Health CO-OP has several services to help you learn more about your health care conditions, how to coordinate your care, and how to manage your medical conditions.

Disease Management

We offer specific Disease Management programs that provide support and education for chronic conditions such as Diabetes and Asthma. If you would like to be considered for one of our Disease Management programs, you or someone who helps you with your care, you can email us at bcby@nevadahealthcoop.org or call 702-786-6064 or 1-855-606-2667.

Complex Case Management

We also have a special program, called Complex Case Management, to help coordinate your care and to provide advice on managing your medical conditions. This program is especially useful if you have multiple medical conditions or if you have recently experienced a major challenge to your health. If you would like to be considered for our Complex Case Management program, you or someone who helps you with your care, you can call us at 702-823-2667 or 1-855-606-2667.

Access to Utilization Management Staff

We understand that you may have questions about how we make decisions regarding what care and services to authorize for you. Our staff are available every work day during normal business hours, toll-free at 855-606-2667.

If you need TDD/TTY services, just call Nevada Relay at 711, and then ask to be connected to 702-823-2667 or 1-855-606-2667.

If your preferred language is not English, we have language services available through bilingual staff and three-way calling to an interpreter service.

Making Decisions about Your Care

We understand how important it is that we make the right decisions about approving coverage for your care. We take this responsibility seriously. When making decisions about approving coverage, we keep to the following rules:

  • Our decisions are based only on the medical necessity of the care and service being requested and if it is a covered benefit.
  • We do not reward practitioners or other individuals in any way for issuing denials of coverage.
  • We have no incentives for decision-makers that would encourage them to make decisions that would result in you receiving less care than you need. We expressly ban these kinds of incentives.

Submitting an Appeal

We understand that you may disagree with a decision that we make. If you do not agree with our decision, you may appeal the decision.

What is an Appeal?

An appeal is your request to us to change our decision about a complaint resolution or coverage for care or treatment issue. We will tell you how to appeal our decisions that might have a negative impact on your coverage or benefits or our relationship as part of the resolution process. We will also help you with the appeal process.

You can mail or fax us your appeal to:

Nevada Health CO-OP
Complaint and Appeals Coordinator
3900 Meadows Lane, Suite 214
Las Vegas, Nevada 89107
Fax: 1-855-897-0318
For assistance filing an appeal please call: 1-855-897-0319

If you need language assistance to help you file an appeal, please let us know. We will provide language assistance at no cost to you. We have bilingual staff and an interpreter service available to help you through the entire process. For TDD/TTY services, please dial 711. Finding the best way to resolve your appeal is an important part of our quality improvement program.

External Review of an Appeal

If our decision is not completely in your favor, you may have the right to have our decision reviewed by health care professionals who have no association with us if our decision involves the following:

  • Making a judgment as to the medical necessity, appropriateness, health care setting; or
  • Level of care or effectiveness of the health care service or treatment you requested.

This is called an external review. You may also have the right to an external review if we have not made our decision within thirty days.

You must submit a request for external review in writing to the Office for Consumer Health Assistance within four months of the date you received our written decision.

To request an external review or to get more information you can contact:

Office of Consumer Health Assistance
Governor’s Consumer Health Advocate
555 East Washington Ave #4800
Las Vegas, NV 89101
(702) 486-3587
(888) 333-1597

Submitting a Complaint

We are committed to providing you the best possible health care experience. We want you to be happy with our services and with the health care that you receive. If you are not satisfied, please tell us. You can call, write, or fax us your complaint to the following areas listed below:

Nevada Health CO-OP
Complaint and Appeals Coordinator
3900 Meadows Lane, Suite 214
Las Vegas, Nevada 89107
CO-OP Care Crew: 702-823-2667 or 1-855-606-2667
Fax Number: 702-802-4601

If you need language assistance to help you file a complaint, please let us know. We will provide language assistance at no cost to you. We have bilingual staff and an interpreter service available to help you through the entire process. Finding the best way to resolve your complaint is an important part of our quality improvement program.