CLAIMS AND APPEALS

Claim Appeal Procedures

If your claim is denied in whole or in part, or if you disagree with the decision made on a claim, you may ask for a review. Your request for review must be made in writing to the Claim Administrator responsible for making the initial determination within 180 days after you receive notice of denial. Appeals should be made to the address indicated on the notice you receive from the Claim Administrator. Appeals involving Urgent Care Claims may be made orally by calling the applicable Claim Administrator at the number listed on the back of your ID card.

Currently, CIGNA and ComPsych maintain a two-level appeal procedure. Caremark® maintains a one-level appeal procedure. If you request a review for a claim’s denial due to an assertion that you or your dependents were not eligible for a benefit, such a request should be made to: