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What will happen when First Medical gets the appeal?


Your appeal will be reviewed by a team of experts that have not been involved with the issue of your appeal. First Medical will make a decision within thirty (30) calendar days. If you have an emergency and First Medical agrees that you do, you can ask for an expedited or fast appeal. You, your doctor or your representative can ask for a fast appeal by calling First Medical at 1-844-347-7800; TTY/TDD users should call 1-844-347-7805, visiting any of First Medical Service Offices, or writing a letter to First Medical at:

First Medical Health Plan, Inc.

Grievance and Appeals Department- FM Vital

PO Box 195079

San Juan, PR 00919-5079

If First Medical agrees to give you a fast appeal, they will decide your case within seventy-two (72) hours. If First Medical does not agree to give you a fast appeal, they will call you within two (2) business days to let you know they will decide your case within thirty (30) calendar days.

If First Medical can’t make a decision within thirty (30) calendar days, they can ask for up to fourteen (14) calendar days. If they ask for more time, they have to let you know why. If you do not agree to give First Medical more time, you can file a complaint.

Once First Medical makes a decision, they will send you a letter within two (2) business days. The letter will tell you what they decided and that you have the right to ask for a hearing if you do not agree with the decision.