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Appeals for Group Members in Illinois

Quartz's mission is to investigate all grievance and appeals appropriately and work to resolve them within the required time period. The State of Illinois defines an appeal as a decision or action by a health care plan that relates to:

  1. health care services including but not limited to procedures or treatments for an enrollee with an ongoing course of treatment ordered by a health care provider, the denial of which could significantly increase the risk to an enrollee's health or

  2. a treatment referral, service, procedure, or other health care service, the denial of which could significantly increase the risk to an enrollee's health
Appeals can be filed orally or in writing. Quartz will review if the situation is urgent or will be handled as a standard appeal.