A reconsideration may be requested by:

• You (the member)
• Your authorized representative
• Your doctor or provider acting on your behalf

You should request a reconsideration if you believe your appeal decision should be changed.

This allows your case to be reviewed again, including any new or additional information that supports your request.

You must request a reconsideration within 60 calendar days of the date on your denial notice.

• Standard requests are typically submitted in writing
• Fast (expedited) requests may be made by phone or in writing
• If you miss the deadline, you may still request a reconsideration if you have a good reason

Yes. You can request a fast reconsideration if your health requires a quicker decision.

• You, your doctor, or your representative can request it
• If your doctor supports your request, it may be expedited automatically
• A decision is typically made within 72 hours for urgent cases 

Once we receive your reconsideration request, we will review your case again, including any new information.

If the decision is not fully in your favor, your case will be sent to an independent review organization outside of Align Senior Care for further review.

Decision timeframes generally include:

• Fast (expedited) Pre-Service requests: within 72 hours
• Standard Pre-Service requests: within 30 days
• Payment requests: within 60 days

You will receive a written notice explaining the decision and next steps.