Your benefits plan provides you the right to appeal a benefit determination. Please explain why you disagree with our benefit determination.

All appeal correspondence should be submitted to the following: Blue Cross and Blue Shield of Alabama Appeals. Post Office Box 10408. Birmingham, AL 35202-0408.

30 сент. 2024 г. · To obtain an aggregate number of grievances, appeals, and exceptions filed with Blue Advantage contact Member Services at 1-888-234-8266 or TTY 711 8 am to 8 ...

30 сент. 2024 г. · To ask for a formal decision about the coverage, if you disagree, print and complete the appropriate form below and fax it to 1-800-693-6703 or ...

Section I: Patient Information. Alpha Prefix. Contract Number (Copy from the member's identification card). Patient Date of Birth (mm/dd/yyyy). Patient Name.

This form will set into motion a review of the data. Please complete this form thoroughly so we can help you with a resolution.

29 нояб. 2017 г. · Claim Number: Date of Service: Your group benefit plan provides you the right to file claims, appeal our decision and obtain information.

Section B. – Appealing on a member's behalf. Do you have legal documents to act on the member's behalf? Yes, I am the legal guardian.

You can use our appeal form or write your own letter. Return it to us by mail, email or fax. Mail: Member Appeal and Grievance. Program.

Section I: Patient Information. Alpha Prefix. Contract Number (Copy from the member's identification card). Patient Date of Birth (mm/dd/yyyy). Patient Name.