The process of appeals & grievances gets very technical, legal, etc. I won’t even attempt to summarize it here. Please follow the links below, check your policy – evidence of coverage and check the law.
Did you use the Correct MD or hospital – Provider List and
Did you Review the procedures in your actual policy, evidence of coverage?
Here’s a sample Speciment EOC Evidence of Coverage – Platinum Plan Page 151
Reasons why the Claim might be denied
Billing Codes – Satire or how it really works?
Free Advice.com WHAT IS THE APPEALS AND GRIEVANCE PROCESS LIKE?
Blue Cross Specimen Policy – Sample Appeals Procedures Page 151
How to gather documents to prove your case – Small Claims Manual
How to create a TIMELINE in Word, Excel, PowerPoint
Appeal Guide – Washington State 62 pages pdf
Todd Friedman, Esq. can help if debt collectors are harassing you when you don’t owe the $$$
Blue Shield – General Info. Appeals & Grievances PO Box 629007 El Dorado Hills , CA 95762 – 9007 Fax: (916) 350 – 7585
Anthem Blue Cross Fined $415K since the California Department of Managed Health Care said it found 40 cases in which Anthem deprived members of their grievance and appeal rights. – CA Healthline 5.3.2016
|Please note that under Health Care Reform – Waiting Periods and Pre-X pretty much are not there!|
|Understanding what you pay and when|
Other Pages in Appeals & Grievances Section
- Covered CA Appeals
- How we can help you with your grievance
- I didn’t use the insurance – I didn’t have my ID Card – Extortion
- Independent Medical Review
- Mistake? Deadline to Report?
- Technical Links – Appeals & Grievances
Blue Cross Summary 6/2011 on how Health Care Reform mandates will be complied with