SHINE HWANG, DBA: SUNSHINE MUSIC

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Following our review of your Grievance, we must Issue a written decision to you and, if applicable, to your representative or provider, within 20-days after receiving the Grievance. The written decision must include: (1) The name(s), title(s) and professional qualifications of any person(s) participating in the First Level Review process. (2) A statement of the reviewer's understanding of the Grievance. (3) The specific reason(s) for the reviewer's decision in clear terms and the contractual basis or medical rationale used as the basis for the decision in sufficient detail for the Insured to respond further to our position. (4) A reference to the evidence or documentation used as the basis for the decision. (5) If the claim denial is based on medical necessity, experimental treatment or similar exclusion, instructions for requesting an explanation of the scientific or clinical rationale used to make the determination. (6) A statement advising you of your right to request a Second Level Review, if applicable, and a description of the procedure and timeframes for requesting a Second Level Review, Second Level Review The -Second Level Review process is available if you are not satisfied with the outcome of the First level Review for an Adverse Determination. Within ten business days after receiving a request for a Second Level Review, we will advise you of the following: (1) the name, address, and telephone number of a person designated to coordinate the Grievance review for the Company; (2) a statement of your rights, including the right to: • attend the Second Level Review • present his/her case to the review panel; • submit supporting materials before and at the review meeting; ask questions of any member of the review panel; • be assisted or represented by a person of his/her choice, including a provider, family member, employer representative, or attorney. • request and receive from us free of charge, copies of all relevant documents, records and other information that is not confidential or privileged that were considered in making the Adverse Determination. We must convene a review panel and hold a review meeting within 45-days after receiving a request for a Second Level Review. We will notify you in writing of the meeting date at least 15-days prior to the date. The review meeting will be held during regular business hours at a location reasonable accessible to you. In cases where a face-to-face meeting is not practical for geographic reasons, we will offer you the opportunity to communicate with the review panel at our expense by conference call or other appropriate technology. Your right to a full review may not be conditioned on whether or not you appear at the meeting. If you choose to be represented by an attorney, we may also be represented by an attorney. If we choose to have an attorney present to represent our interests, we will notify you at least 15 working days in advance of the review that an attorney will be present and that you may wish to obtain legal representation of your own. The panel must be comprised of persons who: (1) were not previously involved In any matter giving rise to the Second Level Review; (2) are not employees of the Company or Utilization Review Organization; and (3) do not have a financial interest in the outcome of the review. A person previously involved in the Grievance may appear before the panel to present information or answer questions. All persons reviewing a Second Level Grievance involving a Utilization Review non -certification or a clinical issue will be providers who have appropriate expertise, including at least one clinical peer. If we use a clinical peer on an appeal of a Utilization Review non -certification or on a First Level Review, we may use one of our employees on the Second Level Review panel if the panel is comprised of 3 or more persons. Grievance r�