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What can I do if don’t agree with the decision?


If you are not satisfied with First Medical’s decision about a complaint or an appeal, you can ask for an Administrative Law Hearing. An Administrative Law Hearing is where you can tell an Official Examiner about the mistake you think First Medical made. You have one-hundred and twenty (120) calendar days from the date of First Medical’s decision to ask for an Administrative Law Hearing with ASES.

You can get more information about Administrative Law Hearings or request one by:

Calling the Vital Call Center at: 1-800-981-2737
Writing ASES at:

ASES

PO Box 195661

San Juan, PR 00919-5661

Sending a fax to ASES at: 787-474-3347

Before the Administrative Law Hearing, you and your representative can ask to look at the papers and records that First Medical will use. First Medical must give you access to those papers and records for free.

During the Administrative Law Hearing, you can give facts and proof about your health and medical care. An Official Examiner will listen to everyone’s side. At the Administrative Law Hearing, you can talk for yourself or you can bring someone else to talk for you like a friend or a lawyer.

The Official Examiner will decide your case within ninety (90) calendar days. If you need a fast decision, the Official Examiner will decide your case within seventy-two 72 hours.

If you do not agree with the Official Examiner’s decision, you can file an appeal with the Court of Appeals of Puerto Rico. More information about how to file an appeal will be in the papers you get after the hearing.