When you or a family member visits a doctor it’s usually for routine care. But, there may be a time when you or a family member needs medical care that involves ongoing doctor visits, out-patient care or a hospital stay. The last thing you want to worry about is a denied claim. To know if a claim is denied you will find the details on your Explanation of Benefits (EOB).
If a claim is denied you have the right to submit an appeal. Anyone can submit an appeal, which is a way to have that decision reviewed. Here are some steps to help you get started.
In most cases, we’ll send a notification within 5 business days after we’ve received your appeal. This is to inform you that it’s in review. After reviewing your appeal in detail, we’ll inform you of the outcome within 30 business days. Please note that this timeline and process can vary based on your case’s urgency and whether we may need more information from you.
Also, keep in mind that there are different appeals that are reviewed by separate groups within BCBSMT.
What if you can’t appeal?You can have an authorized representative, doctor, facility or other health care practitioner submit an appeal for you. But you need to give written or verbal permission for someone else to submit your appeal, unless it’s an urgent care appeal.
Still have questions? Call us at 855-258-8471 or the number on the back of your member ID card.
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