Requesting an Appeal Sample Clauses

Requesting an Appeal. A request for an internal appeal must be submitted by the claimant within six (6) months of the date the Claim was processed, or Adverse Benefit Determination was made. The request should include the following information: 1) state that it is a request for an appeal; 2) the name and relationship of the person submitting the appeal; 3) the reason for the appeal; 4) any information that might help resolve the issue; 5) the date of service/claim; and 6) if possible, a copy of the Explanation of Benefits (EOB). This information should be submitted to BCBSNE at the address and telephone number listed on the Covered Person's ID card. Within three days after receipt of a request for an appeal, BCBSNE will provide the claimant an acknowledgment of the receipt of the appeal. This notice will include the name, address and telephone number of a person to contact regarding coordination of the review. A claimant does not have the right to attend, nor to have a representative in attendance at the appeal review, but may submit additional information for consideration.