The Cleveland Clinic Corporate Employee Health Plan (EHP) Customer Service Unit is open Monday through Friday from 7:30 a.m. to 3:30 p.m. A trained representative is available to answer health plan benefit questions. The Cleveland Clinic EHP Customer Service Unit will be able to assist you with Medical, Behavioral Health/Substance Abuse, and Prescription Drug questions and issues. If you have questions regarding any other benefit coverage you must contact the Benefits Call Center at 216-448-0600.

The Cleveland Clinic Corporate EHP Customer Service Unit is responsible for providing key information regarding the Cleveland Clinic EHP benefits. You can contact us by:

Click for Frequently Requested Forms

Appeal Process

The Cleveland Clinic Corporate Employee Health Plan Administrative Office (CEHPAO) has established an appeal process for medical, behavioral health/ substance abuse, pharmacy, dental or vision coverage including:

1. A determination regarding benefits under the program(s).
2. Appropriateness of reimbursement.
3. Medical necessity and appropriateness of the services furnished or proposed to be furnished.
4. Appropriateness of the setting in which the services were or are proposed to be furnished.

Routine Appeal Process

Prior to initiating the appeal process with the Cleveland Clinic CEHPAO, the employee MUSTcontact the Cleveland Clinic EHP Third-Party Administrator (TPA) Customer Service Department and complete the TPA appeal process. If the situation is not resolved to the employee’s satisfaction through the TPA appeal process, the employee should contact the EHP Customer Service Unit at 216-448-0800 or toll-free 1-866-811-4352. Before calling, the employee must have all the information and paperwork sent to and received from the TPA as well as the name of the phone number of the contact person at the TPA. The EHP Customer Service Unit will instruct the employee on the next steps to take to resolve the issue and can provide you with the appropriate appeal form.

A routine appeal must be resolved within 45 days of the initial request if the required documents to conduct the appeal are submitted. Appeals must be submitted within 180 days of the date of initial coverage decision.

View and print the Appeal Form by clicking here.
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Expedited Appeal Process

If the appealing party believes that the initial determination could seriously jeopardize the life or health of the employee or the employee’s dependent or the ability to regain maximum function, the CEHPAO will consider this a request for an expedited appeal. The CEHPAO personnel, in consultation with the Cleveland Clinic EHP Medical Director, reserve the right to disallow the employee use of the expedited appeal process if, in the sole exclusive opinion of the Cleveland Clinic EHP Medical Director, a non-expedited appeal would in no way seriously jeopardize the life or health of the employee or employee’s dependent. Such appeals will follow the Appeal Process guidelines. Expedited appeals must be resolved within 72 hours of the initial request. The CEHPAO will immediately research the adverse determination by:

1. Reviewing all supporting written documentation in the Cleveland Clinic EHP possession.
2. Making reasonable efforts to obtain additional documentation if indicated.
3. Discussing the matter with the Cleveland Clinic EHP TPA, MBHS, the employee, physician, or ancillary provider.
4. Discussing the matter with the individual who made the initial determination.

Role of Cleveland Clinic Employee Health Plan Advisory Committee

If it is determined that the appeal cannot be resolved through the TPA, the CEHPAO, or Compensation/ Benefit review process, the case will be forwarded to the Health Plan Advisory Committee (HPAC) for Third Level Appeal Review. Physician members of the Cleveland Clinic Employee Health Plan Advisory Committee must hold a current, active, unrestricted license to practice and be Board Certified. Other Committee members include the EHP Medical Director, EHP Senior Director, Legal Counsel, Senior Director Compensation and Benefits, EHP Chief Medical Director, Cleveland Clinic Medical Director, Director Health and Welfare Benefits, Director Retirement/Voluntary Benefit Plans, EHP Director, Care Management, EHP Pharmacist, and Behavioral Health Representatives. Appeal decisions made by the Cleveland Clinic CEHPAO or the HPAC are final and binding. If you are dissatisfied with an appeal decision, refer to Section Six, A Statement of Your Rights Under ERISA in the Cleveland Clinic EHP Summary Plan Description (SPD).