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BCBS TIMELY FILING FOR APPEALS HOW TO

At that time, you or your representative can tell why you need the service the health plan denied. Most State Fair Hearings are held by telephone. If you ask for a State Fair Hearing, you will get a packet of information letting you know the date, time and location of the hearing. If you do not request a State Fair Hearing by this date, the service the health plan denied will be stopped. ) the day the health plan’s internal appeal decision letter says your service will be reduced or end.) 10 calendar days following the date the health plan mailed the internal appeal decision letter, or.You have the right to keep getting any service the health plan denied or reduced, based on previously authorized services, at least until the final State Fair Hearing decision is made if you ask for a State Fair Hearing by the later of: To ask for a State Fair Hearing, you or your representative should either send a letter to the health plan at: If you do not ask for the State Fair Hearing within 120 days, you may lose your right to a State Fair Hearing. You or your representative must ask for the State Fair Hearing within 120 days of the date on the health plan’s letter with the internal appeal decision. A State Fair Hearing is when the Texas Health and Human Services Commission (HHSC) directly reviews our decisions with your medical care. If your appeal is denied, you have the right to ask for either a non-emergency or emergency State Fair Hearing or External Medical Review. State Fair Hearings and External Medical Reviews If you qualify for an emergency health plan appeal, we must decide to approve or deny your appeal within 72 hours of your request. If you feel your health will be seriously harmed by waiting for a decision on your health plan appeal, you or your doctor can ask for an emergency health plan appeal. Call us at 1-87 if you think this form will not reach us by mail before the deadline. You must request for your services to continue by 10 days from the date this notice is mailed, or the date services will change. We will give you a decision on your appeal within 30 days.

You must request an appeal by 60 days from the date your notice for denial of services was mailed. Call a Member Advocate for help filing an appeal at 1-87 (TTY: 711).Call the BCBSTX Customer Advocate Department toll-free at 1-88 (TTY: 711), Monday through Friday, 8 a.m.Mail or fax it to us using the address or fax number listed at the top of the form. Fill out a Health Plan Appeal Request Form.When you file an appeal, we will take another look at your case and see if there is something more we can do to help. Your appeal can be filed by your health care provider, friend, relative, lawyer or anyone else you choose.

It is taking a long time to get the service you asked for.

You had a service approved before, but now it is ending.

You did not get all the services approved that you asked for.

You are not getting a service you wanted.

Not happy with a decision that was made about your care? You can file an appeal. You can write or call:īCBSTX Customer Advocate Department: 1-88 (TTY: 711) You, your provider, or someone you trust can file a complaint with BCBSTX. The decision letter will have the reasons why we made the decision. We will send you a letter with our decision within 30 calendar days of the day we get your complaint in writing. This might include providers, facilities, health plan staff or others. While BCBSTX is looking into your problem, we will be getting facts from all the parties involved in your complaint. You can include more information that will help us resolve your complaint. You can complete the complaint form and return it to us. If your complaint was received orally, the acknowledgement letter will include a complaint form. BCBSTX will send you an acknowledgement letter within 5 business days of our receipt of your complaint telling you that we received it. You have the right to give written comments, documents, or other information for your complaint either by calling or in writing.

BCBS TIMELY FILING FOR APPEALS HOW TO

Read the HHSC How to Submit a Complaint flyer to find out how to file a complaint. You can file a complaint by phone or ask for a complaint form to be mailed to you. If you have a complaint about a service or care you received from Blue Cross and Blue Shield of Texas (BCBSTX) or one of our providers, please call a Customer Advocate at 1-88 (TTY: 711).