UNDER DENTAL MANAGED CARE
IF YOU DO NOT AGREE WITH THE APPEAL DECISION, YOU MAY REQUEST A STATE FAIR HEARING
OR FILE FOR A STATE FAIR HEARING . YOU MUST FILE AN APPEAL WITH LIBERTY BEFORE YOU CAN
FILE A STATE FAIR HEARING
HOW TO FILE FOR A STATE FAIR HEARING REQUEST
If you filed an appeal and received a “Notice of Appeal Resolution” (NAR) letter telling you that your dental plan
will still not provide the services in full or in part, or you did not receive a letter telling you of the decision
and it has been more than 30 days, you may ask for a “State Hearing” and a judge will review your case.
If you are currently getting treatment and you want to continue getting treatment while the State Hearing
is pending, you must tell us within 10 days from the date this letter was postmarked or delivered to you; OR
before the date your dental plan says services will stop. You must say that you want to keep getting treatment
while the State Hearing is pending. You may have to pay for the cost of any continued benefit if the final
decision is not in your favor.
If you want a State Hearing, you must ask for one within 120 days from the date of the NAR letter. You can ask
for a State Hearing by phone or in writing:
By phone: Call 1-800-992-0900 EXT. 43604 between 8:00 a.m. to 5:00 p.m., Monday through Friday. If you
cannot hear or speak well, please call TTY/TDD 7-1-1. This number can be very busy. You may get a message
to call back.
In writing: Fill out the State Hearing form included in your NAR letter or send a letter to Nevada Division of
Health Care Financing and Policy Hearings, 1100 E. William Street, Suite 101 Carson City, NV 89701; Fax
to: 1-775-684-3610.
Be sure to include the member’s name, address, telephone number, date of your NAR and the reason you want
a State Hearing. If someone is helping you ask for a State Hearing, add their name, address, and telephone
number to the form or letter. If you need an interpreter, tell us what language you speak. You will not have to
pay for an interpreter, We will get you one.
After you ask for a State Hearing, it could take up to 90 days to decide the case and send an answer. If you think that
waiting that long will hurt your health or dental function, they might be able to get an answer within 3 working
days. Ask your dentist or dental plan to write a letter for you. The letter must explain in detail how waiting 90
days for your case to be decided will seriously harm your health or dental function. Then, make sure you ask for
an “expedited hearing” and provide the letter with your request for a hearing.
You may speak at the State Hearing yourself. You may have a relative, friend, advocate, dentist, doctor, or
attorney speak for you. If you want another person to speak for you, then you must tell the State Hearing office
that the person is allowed to speak on your behalf. This person is called an “authorized representative.”
LEGAL HELP
You may be able to get free legal help by calling the telephone numbers below.
Nevada Legal Services - Clark County: 702-386-0404 or 1-866-432-0404
Nevada Legal Services - Washoe County: 775-284-3491 or 1-800-323-8666
Revised 09.04.19