An appeal is a request contesting a denial or reduction of coverage for services which have been availed or intended to be received..
An appeal should be submitted to Daman within 30 days following Daman’s decision of denying or reducing coverage for a service that was availed or intended to be received.
Following is a general description of the appeal process. To begin, download and complete the Appeal/ Exception Request Form.
Please specify why you believe the claim or service should be covered. Include any documentation that supports your appeal with the form.
Your request will be reviewed by a partywhowas not involved in the initial decision and can take corrective actions. Decisions will be based upon the terms of your benefits plan. A physician will be involved in any review that involves medically necessary cases.
You will be notified of the appeal decision after 30 calendar days. If you are not satisfied with Daman’s decision, you may request another review (2nd appeal) with additional comments detailing your position.
If the appeal involves a coverage decision based on issues of medical necessity or experimental treatment, a senior clinician will be involved in this review.
If you are not satisfied with our post appeal decision, other remedies may be available to you. In such cases, you can appeal our decision by applying for an external review to Health Authority – Abu Dhabias per HAAD’s appeals process.To learn more, call Customer Service 800-432626
Submitting an appeal:
In order to initiate the appeal process, you must submit the Appeal/Exception Request Form along with the following supporting documents:
• Copy of Daman card
• Copy of Emirates I.D. (or other official ID e.g. Passport, Driving License etc.)
• Copy of prescription
• Original itemized Invoices with date /payment receipt
• Medical Declaration from physician