Commission for Case Manager Certification (CCMC) Exam 2025 – 400 Free Practice Questions to Pass the Exam

When an appeal is denied in healthcare services, the next expected step is the right to request a fair hearing. This process allows individuals to seek an objective review of the denial made by the healthcare provider or insurer. A fair hearing serves as a formal method to contest the decision and provides an opportunity for the individual to present their case, which can lead to a resolution or reversal of the denial.

This option is integral to maintaining accountability within the healthcare system, ensuring that patients uphold their rights for services and have access to necessary oversight. Should the hearing result in favor of the patient, they may receive the services or coverage they initially requested. This step is critical as it reflects the legal and procedural rights individuals have in challenging decisions regarding their healthcare.

The other choices do not accurately reflect the procedures following a denied appeal. For instance, automatic eligibility for further services would imply that the denial has no impact on future coverage, which is not the case. Redefining service criteria suggests a change in policy or eligibility requirements, rather than addressing the specific denial. Lastly, marking the end of the dispute process does not align with the available rights of individuals to challenge a denial through a formal fair hearing.