The following is a statement from Fidelis Care New York Public Relations Manager Ann Hughes:
Although Fidelis Care cannot comment on an individual member's care due to confidentiality rules, the health plan's decisions about addiction treatment are based upon state and national standards of care, including guidelines from the New York State Office of Alcoholism and Substance Abuse Services and the American Society of Addiction Medicine. Fidelis Care administers all benefits in accordance with State Department of Health regulations. Addiction treatment is provided through a variety of approaches, and denial of a specific level of care does not mean that no treatment is necessary. We are committed to helping all members receive the quality care or treatment they need in the most appropriate setting.
The State Department of Health provides a process by which a member or provider can appeal a denial by a health plan. If a member or provider disagrees with a decision regarding care, he or she has various options, including
1) filing an appeal to be decided by a different Fidelis Care doctor than the one who made the initial determination; and
2) requesting an external appeal that is conducted by an independent expert through the Department of Financial Services. In addition, the member may request a fair hearing before an independent judge selected by the state.