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Doctor visits are generally routine, but you or a family member may one day require medical care that involves ongoing doctor visits, out-patient care or even a hospital stay. If that day comes, 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) and keep track of all your claims in Blue Access for Members (BAM).
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. These steps will get you started.
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. One thing to note—different appeals are reviewed by separate groups within BCBSIL. There are various types of appeals meant for specific situations and each appeal has a specific reviewer assigned to it. Here’s a guide to understanding appeals:
We’ll usually send out a notification within 5 business days after receiving your appeal to inform you that it’s in review. After your appeal has been fully reviewed in detail, we’ll let you know the outcome in writing within 30 business days. However, this timeline and process can vary based on your case’s urgency and if we may need more information from you.If you still have questions, you can contact us at 800-538-8833 or the number on the back of your member ID card. We’re happy to help!
Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association
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