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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.
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. Also, keep in mind that there are different appeals that are reviewed by separate groups within BCBSTX.
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.Still have questions? Call us at 888-697-0683 or the number on the back of your member ID card.
Dear BCBS: I’ve been diagnosed with pneumonia, pleural effusion and a a partially collapsed lung. Both my internist and pulmonologist have ordered CT scans, which has been denied as not medically necessary by your agent Evicore. Given the urgency of my condition, I may have to pay cash for the diagnostic. We pay thousands a year in premiums and the university that holds the policy insures a number if employees. Your rationing of health care and denial of an obviously needed diagnostic is unconscionable. It also violates several Texas statues including the Texas Deceptive Trade Practices Act. Not only will the university consider dropping your plan, we may be required to seek redress through legal process. Others similarly situated may take note.
Hello tbrich, I'm very sorry you're dealing with this. If there's anything we can do to help please send us a private message. ~ Kayla
Bcbs Texas denied my back fusion 3 days before surgery! In miserable pain every single day and bsbc could care less, 30 days to review a appeal what a joke! bcbs is a joke!! We have a business with over 30 people on bsbc, will be finding another insurance source after this year.
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