79 If your claim for a Specialty Medication is an Urgent Claim, you will be notified of CVS Caremark ’s determination more quickly. The definition of an Urgent Claim is as set forth in the health benefit claims section above. For Urgent Claims for Spe cialty Medication, CVS Caremark will notify you of its determination as soon as possible, taking into account the medical exigencies, but no later than 72 hours after you first call CVS Caremark about the prescription for the Specialty Medication, unless y ou or your physician fail to provide sufficient information to make the determination, in which case you will be notified within 24 hours of the information that is needed. The determination will then be made no more than 24 hours after CVS Caremark receiv es the information. Appeals of Prescription Drug Claims Denied by CVS Caremark A. First Level Appeal If you disagree with a determination made by CVS Caremark on any prescription drug claim, you must first submit a request for appeal by contacting CVS Carema rk customer care at 800 - 282 - 8503 within 180 days of receipt of your denial notice. You should state the reason why you believe your appeal should be approved and include any information supporting your appeal. First level appeals received more than 180 day s after the date you receive the denial or adverse determination notice of the claim will be denied as untimely. Non - Specialty Drugs: For appeals of denied claims that do not involve Specialty Drugs, CVS Caremark will notify you of a decision within 30 days of receip t of your request for review. Specialty Drugs: For appeals not involving Urgent Claims, CVS Caremark will notify you of its decision within a reasonable pe riod of time appropriate to the medical circu mstances, but in no event will CVS Caremark take more than 15 days to notify you of its decision. Urgent Claim: If the Specialty Medication appeal involves a denied Urgent Claim, CVS Caremark will decide the ap peal as soon as possible, taking into account the medical exigencies, but no later than 72 hours after receipt of the appeal. If CVS Caremark denies your appeal, you have the right to request a second level appeal with the Board of Trustees of the National IAM Benefit Trust Fund . B. Second Level A ppeal If CVS Caremark denies your appeal, you have the right to request a second level appeal with the Board of Trustees of the National IAM Benefit Trust Fund. You should submit your second level appeal to the Fund Office after you receive the first lev el appeal denial, but within 90 days of receipt of CVS Caremark’s denial notice on the first level appeal review . Your second level appeal should include a copy of the first level appeal denial , and any information supporting your appeal. Second lev el appeals received more than 9 0 days after receipt of the first level appeal denial notice will be denied as untimely. Th e Board of Trustees will review your appeal on the date of the first Board meeting that immediately follows the Plan’s receipt of your req uest for review, unless the request for review is filed within 30 days preceding the date of such meeting. In such case, a benefit determination may be made on the date of the second meeting following the Plan’s receipt of the request for review. If s pecial circumstances require a further extension of time for processing, a determination will be made no later than the third meeting following the initial receipt of the appeal. If an extension is required, you will be notified of the extension and the re asons for it prior to the commencement of the extension. If the Specialty Medication appeal is related to a denied Urgent Claim, the final decision on the appeal will be made as soon as possible, taking into account the medical exigencies, but no later th an 72 hours after receipt of the appeal by the Fund Office.
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