Denials. A claim denial, also known as an adverse benefit determination, is any of the following: • a full or partial denial of a benefit; • a reduction of a benefit; • a termination of a benefit; • a failure to provide or make a full or partial payment for a benefit; and • a rescission of coverage, even if there is no adverse effect on any benefit. If we deny payment for a service we determine not medically necessary, a determination letter will be provided with the following information: • reason for the denial; • clinical criteria used to make the determination as well as how to obtain a copy of the clinical criteria; and • instructions for filing a medical appeal.
Denials. A claim denial, also known as an adverse benefit determination, is any of the following: • a full or partial denial of a benefit; • a reduction of a benefit; • a termination of a benefit; • a failure to provide or make a full or partial payment for a benefit; and • a rescission of coverage, even if there is no adverse effect on any benefit. If we deny payment for a service we determine not dentally necessary or not medically necessary (orthodontic services), a determination letter will be provided with the following information: • reason for the denial; • clinical criteria used to make the determination as well as how to obtain a copy of the clinical criteria; and • instructions for filing an appeal. If you have questions, please contact Blue Cross Dental Customer Service. See Section 9 for contact information. You may also contact the Office of the Health Insurance Commissioner’s Consumer Resource Program (RIREACH) at 1-855-747-3224 about questions or concerns you may have. Complaints A complaint is an expression of dissatisfaction with any aspect of our operation or the quality of care you received from a dentist. A complaint is not an appeal. For information about submitting an appeal, please see the Appeals section below. We encourage you to discuss any concerns or issues you may have about any aspect of your dental treatment with the dentist that furnished the care. In most cases, issues can be more easily resolved if they are raised when they occur. However, if you remain dissatisfied or prefer not to take up the issue with your dentist, you can call Blue Cross Dental Customer Service for further assistance. You may also call Blue Cross Dental Customer Service if you are dissatisfied with any aspect of our operation. If the concern or issue is not resolved to your satisfaction, you may file a verbal or written complaint with Blue Cross Dental Customer Service. We will acknowledge receipt of your complaint or administrative appeal within ten (10) business days. We will conduct a thorough review of your complaint and respond within thirty (30) business days of the date it was received. The determination letter will provide you with the rationale for our response as well as information on any possible next steps available to you. When filing a complaint, please provide the following information: • your name, address, member ID number; • the date of the incident or service; • summary of the issue; • any previous contact with BCBSRI concerning the issue; ...
Denials. The CONTRACTOR shall:
Denials. A claim denial, also known as an adverse benefit determination, is any of the following: • a full or partial denial of a benefit; • a reduction of a benefit; • a termination of a benefit; • a failure to provide or make a full or partial payment for a benefit; and • a rescission of coverage, even if there is no adverse effect on any benefit.
Denials. If a claim for a Retirement Benefit under the Agreement is wholly or partially denied, notice of the decision shall be furnished to the claimant by the Administrator within a reasonable period of time after receipt of the claim by the Administrator.
Denials. In the event a request for voluntary transfer is denied, a unit member may 21 reapply during the internal promotional process.
Denials. A. By entering into this Agreement, Hilcorp shall not be deemed as admitting any violation of the OPA and OSPRA or any rules or regulations promulgated there under.
Denials. A. By entering into this Agreement, Unocal shall not be deemed as admitting any violation of the OPA and OSPRA or any rules or regulations promulgated there under.
Denials. A denial of a request for flextime will contain the reasons for the denial in writing to the employee within ten working days of the request being submitted.
Denials i. The CONTRACTOR shall clearly document in English or Spanish, as appropriate, on a form agreed to by HSD, and communicate in writing the reasons for each denial. A “
